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Medical Forum / General / Dentistry / August 2005Pain after amalgam removal
Hello, I recently had four amalgam fillings replaced by composite; they where about 25 years old and the dentist said they needed replacement before they 'cracked' the teeth. Of the four, one molar was especially painful during drilling and I had to get it frozen before he could proceed (the others were ok without freezing). After a week, that one molar is still painful. The dentist mentioned I could have sensitivity / pain for a couple of weeks; but that one molar constantly aches, often I can feel the pain right up to my eye socket. Thats just on its own mind you. If I actually get that tooth hot or cold then the pain is terrible and lasts for a long time. So for now I am careful to only ingest room temperatures food / drinks and chew on the 'good' side of my mouth mostly. I am starting to really regret having the filling replaced - I had zero problems beforehand. Thought I'd check for opinions here before I get back to my dentist shortly. Its only been a week so not sure whether this could just be passing inflammation from the filling. Thanks! "Praxus" <nextgen35@yahoo.com> wrote in message ... > Hello, > > I recently had four amalgam fillings replaced by composite; > they where about 25 years old and the dentist said they needed > replacement before they 'cracked' the teeth. Filling do NOT crack teeth. Not ever. It is harmful and destructive sleep patterns which damage teeth. Old amalgam fillings which are well sealed, providing good occlusion and good contact to adjacent teeth do not need to be replaced for preventative reasons. > Of the four, one molar was especially painful during drilling and I had > to get it frozen before he could proceed (the others were ok without > freezing). Not really significant to your present symptoms > After a week, that one molar is still painful. The dentist mentioned I > could have sensitivity / pain for a couple of weeks; but that one molar [quoted text clipped - 4 lines] > room temperatures food / drinks and chew on the 'good' side of my > mouth mostly. This is more pertinent. You might be needing a root canal treatment soon. (only a guess from a computer monitor). > I am starting to really regret having the filling replaced - I had > zero problems beforehand. Thought I'd check for opinions here > before I get back to my dentist shortly. Its only been a week so > not sure whether this could just be passing inflammation from the > filling. Thanks! Now, I have no idea of the condition of the tooth before or after treatment. It is certainly possible that the dentist gave you a very simplified explanation, and in reality the old filling was in terrible condition and the tooth was in tough shape--so a RCT would be a likely possibility with or without treatment. However, if the dentist only took the filling out because he scared you with the worry that it would crack a tooth, but the filling was perfectly sound, then I have to ask how good a dentist this person was that they have to resort to scare tactics to get any work. Again, I don't know the specifics, and the dentist may be the most honest sincere highly skilled guy on this planet (next to us SMD regulars <VBG>), or not.  Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... Out of curiosity, where did the notion that amalgam fillings crack teeth arise? It seems to be quite a widespread assumption, esp. among dentists who specialize in cosmetic dentistry. > Out of curiosity, where did the notion that amalgam fillings crack > teeth arise? It seems to be quite a widespread assumption, esp. among > dentists who specialize in cosmetic dentistry. I think you answered your own question. ;-) Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > > Out of curiosity, where did the notion that amalgam fillings crack > > teeth arise? It seems to be quite a widespread assumption, esp. among > > dentists who specialize in cosmetic dentistry. > > I think you answered your own question. ;-) LOL ;-P - but is there anything to it?? They make the argument with a lot of... conviction (I'm fairly sure they genuinely believe this to be the case). It has to do with little minds seeing that most of the very old fillings in cracked teeth seem to be amalgam. They forget that most of the old fillings ARE amalgam. They talk about the 0.5% expansion rate of amalgam and forget about the 5-10% thermal expansion of composites. Today, both numbers are smaller, but the numbers would be close for 15+ year old stuff. Mostly it is self-fulfilling prophesy. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >> > Out of curiosity, where did the notion that amalgam fillings crack [quoted text clipped - 6 lines] > lot of... conviction (I'm fairly sure they genuinely believe this to be > the case). Whatever the research says I hold that amalgams expand and crack teeth. I've seen it tooooo many times. The other day was classic. There was a lingual pit amalgam on #11, obviously had been there a long time. There were probably 10-15 cracks emanating from the amalgam like spokes on a wheel. I've never seen a pattern like that around a composite or on a natural, unrestored tooth. The amalgam caused the cracks. > It has to do with little minds seeing that most of the very old fillings in > cracked teeth seem to be amalgam. They forget that most of the old fillings [quoted text clipped - 25 lines] > > lot of... conviction (I'm fairly sure they genuinely believe this to be > > the case). Cutting a prep like that with a carbide bur which is dull will cause those cracks. Coupled with parafunction to expand them. You are trying to prove my point. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > Whatever the research says I hold that amalgams expand and crack teeth. > I've [quoted text clipped - 41 lines] >> > lot of... conviction (I'm fairly sure they genuinely believe this to be >> > the case). Disagree, very likely it has to do with the bur used to prepare the tooth. 557's cause microfractures during preparation. There are other burs just as bad. Am now using 331, 331L, and 245's for most preps. >Whatever the research says I hold that amalgams expand and crack teeth. I've >seen it tooooo many times. The other day was classic. There was a lingual [quoted text clipped - 36 lines] >> > lot of... conviction (I'm fairly sure they genuinely believe this to be >> > the case). -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > > > Out of curiosity, where did the notion that amalgam fillings crack > > > teeth arise? It seems to be quite a widespread assumption, esp. among [quoted text clipped - 5 lines] > lot of... conviction (I'm fairly sure they genuinely believe this to be > the case). I haven't noted a problem with amalgams causing fractures, then again, I am against cosmetic dentistry, and have been placing anterior amalgams and plaid crowns for years. I also like to reverse teeth on dentures, placing uppers on lower and vice versa. It is most esthetically unpleasing! To me it is yet another example of how twisted of logic has permeated all areas of society. Tooth has amalgam, tooth broke, amalgam must have caused break. Another example I read recently...patient has sleep apnea, patient has high blood pressure...sleep apnea must cause high blood pressure...there was no mention of the fact that almost all apnea sufferers are grossly obese...nah, you can sell more apnea appliances by passing it off as a cure for high blood pressure. T > Another example I read recently...patient has sleep apnea, patient has high > blood pressure...sleep apnea must cause high blood pressure...there was no > mention of the fact that almost all apnea sufferers are grossly obese...nah, > you can sell more apnea appliances by passing it off as a cure for high > blood pressure. Not to change the subject, but since you bring that up... Have you ever seen anyone go for one of those sleep studies and NOT end up having one of those machines prescribed? Vaughn It is really impossible to diagnose your problem without seeing you. I would contact your dentist immediately and explain the problem and see what he says. It could resolve itself, but even if the pain goes away, there still could be a problem. See your dentist and have it checked today! > Hello, > [quoted text clipped - 20 lines] > not sure whether this could just be passing inflammation from the > filling. Thanks! Posterior composites can be done so that there is little or no sensitivity after placement unless there is already a problem with a particular tooth. The materials and techniques are better understood today than ever, but there are still dentists using either the wrong materials, wrong technique, or both. Pain of this nature could be from several causes: Poor placement of the restorations Clenching on a 'high spot' Trauma from the procedure damaging the pulp (deep filling or cracks in the tooth) I see lots of broken, cracking, failing amalgams in my practice. As people reach middle age with 20-30 yr.-old fillings (that are often pretty wide anyway and have been replaced/enlarged once or twice), these teeth need help to last another 20-40 years. Cutting out an amalgam and replacing it with composite is not going to be a great help. These teeth need crowns and/or onlays. If there are no signs of the restoration failing, cutting on the tooth 'so it won't fail' is suspect. JMO, Fawks > Hello, > > I recently had four amalgam fillings replaced by composite; > they where about 25 years old and the dentist said they needed > replacement before they 'cracked' the teeth. > I am starting to really regret having the filling replaced - I had > zero problems beforehand. Thought I'd check for opinions here > before I get back to my dentist shortly. Its only been a week so > not sure whether this could just be passing inflammation from the > filling. Thanks! Thanks for the replies. I've noticed that 400 mg of Ibuprofen gets rid of the pain for quite a few hours. Didn't take a pill before bed (to see if it was getting better) and still woke up with a constant dull ache in the tooth - so I guess not really ! The dentist did mention that the tooth aching now was the one with the most damage (since it hurt as soon as he started drilling almost) so I'm hoping its just temporary trauma to the pulp...but regardless will go back tomorrow if there's no improvement. If I end up having to get a root canal cause the nerve was permanently damaged due to a likely unnecessary filling replacement; I'll be reallly pissed ! Probably once I get this resolved I'll switch dentists. After reading about it pretty extensively; it seems doubtful that all 4 or 5 amalgams that he replaced ( all at once too ) really needed it. Patients often need multiple fillings replaced at one time, because they were initially placed at one time and all fail due to the same causes. Most likely, if you now need a root canal treatment, you would have needed it before too long anyway. Taking out amalgam fillings because they might crack teeth, is not good treatment. Taking out failing amalgam fillings and only mentioning that they sometimes see fractures under them, is a bit better. Taking out amalgam fillings and explaining to the patient that the margins have failed, that there is new decay, that the metal has cracked, etc. are much better examples of communication. Dentists are sometimes very busy and forget to take the time to communicate fully with each patient. Especially if the patient looks to have a good understanding of what is going on. From your description, I would suspect that the amalgam containing tooth had other problems besides the fact that the dentist did not like the material. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > Thanks for the replies. > [quoted text clipped - 19 lines] > that he replaced > ( all at once too ) really needed it. Time for a follow up to this lame situation. After I had pain in that one molar for a week I went back to my dentist as advised by some replies here. He found that the sensitivity was by the gum and not through the filling and just advised me to rub sensodyne on it. He didn't seem concerned that the tooth had moderate continual pain; and said it should get better; but to come back if it got worse. For the next 2 weeks I had the same symptoms with zero improvement. Ibruprofen controlled the pain quite well. That is, until friday afternoon; at which point the pain increased a lot and all of a sudden ibuprofen wouldn't work anymore ! The next day the pain got so bad I couldn't take it, and as it was (still is) the weekend I had to go to an emergency dental clinic. Well joy, they diagnosed a necrotic pulp and periapical lesion. I tell ya I have never enjoyed a freezing shot as much as I did at that visit ! From agony to no pain..at least for a little while ! Anyways they prescribed penicillin and tylenol 2 (not quite strong enough imo) and said I needed to see my dentist this week for a root canal. The dentist said that what had happened was a possible risk of replacing old fillings...but my dentist had never told me that, or mentioned any adverse risks at all. At this point I am wondering if he is guilty of enough negligence to involve a lawyer. I am thinking I will at least talk to him about doing the root canal for no charge. This is an awesome lesson for anyone considering replacing old amalgams. Go to a second dentist and get another opinion about whether its really necessary...or possibly face weeks of pain and the gutting of what used to be a perfectly good tooth. it is possible in my (patient's) opinion, the dentists here would advise going to an endodontist for the root canal. Your regular dentist, having done the damage (with your permission?) to have the amalgam filling replaced (not intentionally, I am sure, but was it necessary?) would not be the ideal person to do the root canal, as it is a specialized procedure if you want the best outcome. Not that your dentist could not do a good job, but I would not risk getting stung twice by the same person. Lousy lesson learned from the past. Gail (who thought every dentist was as good as another) > Time for a follow up to this lame situation. > After I had pain in that one molar for a week I went [quoted text clipped - 29 lines] > whether its really necessary...or possibly face weeks of pain and > the gutting of what used to be a perfectly good tooth. > The next day the pain got so bad I couldn't take it, and as it > was (still is) the weekend I had to go to an emergency dental clinic. [quoted text clipped - 7 lines] > risk of replacing old fillings...but my dentist had never told me that, > or mentioned any adverse risks at all. Aside from the local anesthetic ("freezing shot"), did the dentist at the emergency dental clinic actually perform any treatment on the tooth itself? > At this point I am wondering if he is guilty of enough negligence > to involve a lawyer. I am thinking I will at least talk to him about > doing > the root canal for no charge. Good luck. It is well established that ANY filling treatment of a tooth, whether a replacement of an old filling or not, involves the remote risk of pulpal necrosis. Thus the presence of pulpal necrosis is NOT proof of negligence. In addition, I don't know of any lawyers who would get involved if the total money involved is only the cost of a root canal and a crown. That may be significant money to you and me, but it's peanuts to a lawyer. Between the lack of demonstrable negligence, and the small amount of money involved, it would be difficult to understand why a lawyer would even consider taking such a case. > This is an awesome lesson for anyone considering replacing old > amalgams. Go to a second dentist and get another opinion about > whether its really necessary...or possibly face weeks of pain and > the gutting of what used to be a perfectly good tooth. Now THAT is good advice! Even a THIRD opinion can help if there is any doubt after the second opinion. - dentaldoc We have no way of knowing the condition of the amalgam prior to replacement, but *any* treatment on a tooth carries *some* risks. Some teeth are 'sleeping dogs' where the next trauma will push them over the edge into needing a root canal. Some teeth even have evidence that shows on an X-ray that they need a root canal, but don't hurt. The nerve should be tested on any tooth with an old amalgam before treatment (in an ideal situation). Some teeth can be cracked (or have a crack enlarge) by drilling out a large, old amalgam. Some dentists still use inappropriate bonding materials or techniques. There may or may not have been any negligence with regards to the actual treatment of this tooth. However, it doesn't sound like you were informed of any possible complications. I doubt that any lawyer is going to be interested in getting involved because a dentist *possibly* caused you to need a root canal. JME, Fawks > At this point I am wondering if he is guilty of enough negligence > to involve a lawyer. I am thinking I will at least talk to him about > doing > the root canal for no charge. > This is an awesome lesson for anyone considering replacing old > amalgams. Go to a second dentist and get another opinion about > whether its really necessary...or possibly face weeks of pain and > the gutting of what used to be a perfectly good tooth. |
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