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Medical Forum / General / Dentistry / July 2007Need advice re root canal
During my routine checkup I was told I needed fillings in two teeth that are next to each other. When the dentist was doing the fillings, I experienced an extremely sharp pain in my cheek (it's upper teeth) and I had to ask them to take the air dryer thingy out of my mouth as it was causing me significant pain. Afterwards, pain from hot and cold was very bad and I went back 2 weeks later where I was told that the filling was "high" and it was ground down. This did not help and I developed sensitivity to sweet things as well as not being able to bite down on the teeth because it hurts. I went back again after a week and they redid the filling saying that the bond was not good and it actually crumbled out when they drilled it (it's the white filling material). This secnd filling does feel better but I am still sensitive to sweets and cold and hot things hurt on it. We are a week past this second filling now and I just went back today where they did another x-ray. The dentist said from my symptoms it sounds like there is some infection there and that I probably also need a root canal. The pain from hot and cold lasts a while - maybe a minute or two, sometimes less, but certainly more than a few seconds. My husband says that it's common for sensitivity to cold/hot after a filling (I don't know, since this is my first one) and that it will go away in time (how long - I can't take it for much longer). In my opinion I should at least be able to enjoy a cold glass of water by now after a week, surely? And what about the sweet sensitivity? Do I really need a root canal? It seems to me that they were either negligent and misdiagnosed my need for a filling (I was feeling NO problems from these two teeth prior to the fillings) or they caused this problem by doing something wrong with the initial filling. Does anyone have any insights? I don't feel like I can trust the dentist because I am afraid they are just covering their a.ses. TIA CY It is impossible to say for sure, but I am concerned about how they redid the filling quickly blaming the bond. *To me* that sounds like this may be a common problem for the way this dentist does posterior composite restorations. Some slight sensitivity might be considered normal, but not what you are describing. I have a few cases every year where a patient shows up with this type of problem. The last one was an assistant for another dentist! After checking an X-ray to make sure the filling was not close to the pulp, I redid the filling with Clearfil SE bond (rubber dam in place). The young lady was fine the very next day. Composites are wonderful materials, but the right materials and techniques are essential for success. I would consider a second opinion from another dentist. JMO, Steve Fawks > I went back again after a week and they redid the filling saying that the > bond was not good and it actually crumbled out when they drilled it (it's [quoted text clipped - 5 lines] > from hot and cold lasts a while - maybe a minute or two, sometimes less, but > certainly more than a few seconds. > CY THe most important thing to have with your dentsit is communication. Give him another chance. Tell him that ou would liek to avoid the root canal. Ask him if he will refill the tooth and place the filling in small increments, preferrably with a flowable type composite first. I use this technique and have little problem with sensitivity, Notice I said little probelm. There is always the cance of sensitivity with silver and especially white fillings. When I used to place amalgam, sensitivity was pretty predictable (almost always there for a few weeks). With *normal sized* composites, it almost never exists unless I have left it high. IME, the bonding system and technique are much more important than layering techniques. JME, D > THe most important thing to have with your dentsit is communication. > Give him another chance. Tell him that ou would liek to avoid the [quoted text clipped - 3 lines] > sensitivity, Notice I said little probelm. There is always the cance > of sensitivity with silver and especially white fillings. It depends... The literature says that placing a composite between cusps may cause more sensitivity during curing shrinkage (stress imparted) than if you are replacing a cusp.... I guess there is always the possibility of hydraulic sensitivity do to action with the dentinal tubules In practice, this is a non-issue (at least in my experience over the last 20+ years of posterior composite use). I'm not saying to bulk fill everything, because I certainly do not. I am saying that bonding materials and techniques are the main issue with posterior composite sensitivity. D > It depends... The literature says that placing a composite between > cusps may cause more sensitivity during curing shrinkage (stress > imparted) than if you are replacing a cusp.... I guess there is > always the possibility of hydraulic sensitivity do to action with the > dentinal tubules I don't think there's much to the 'curing stress" theory myself. Since following your recommendations, we have virtually *zero* post-op sensitivity. Depending on the specific situation of course, CFSE --> flowable where indicated --> Z250 in one or two increments works very well. For those huge build ups am using Fuji 9 and tell the patient it is only temporary until we can make a crown. Now using Captek for posterior porcelain, and have used it in a couple of FPD's. Works very well. For anteriors needing maximum esthetics am using Chromatech all ceramic. These must be bonded. >In practice, this is a non-issue (at least in my experience over >the last 20+ years of posterior composite use). [quoted text clipped - 10 lines] >> always the possibility of hydraulic sensitivity do to action with the >> dentinal tubules I only use incremental build-up when I want to layer in different shades, or when I need to support a matrix before getting full contour loaded in.  Signature/ Amatus / > > I don't think there's much to the 'curing stress" theory myself. [quoted text clipped - 29 lines] >>> always the possibility of hydraulic sensitivity do to action with the >>> dentinal tubules So far I have seen a total of 3 dentists at the same practice. Next Friday I have an appointment with yet another and I am starting to lose patience. The filling itself doesn't feel right, although they have used that special paper on it countless times and smoothed it down (which in itself is agony). So, I guess my question is, how many chances do I give these guys? The one that redid my filling said that these type of fillings are very "technique specific", but that the original dentist did not do anything wrong (I beg to differ since it was fine until she touched my tooth). I have started antibiotics but have so far not noticed a change although the length of time of the senstivity has reduced a bit to maybe 5-7 seconds, although there is pain in my cheek for considerably longer. Should it still be sensitive to sweet and biting down, regardless of the hot/cold thing? And when I go back can I specifically request this Clearfil? I really appreciate everyone's replys, thank you so much. CY > It is impossible to say for sure, but I am concerned about how they > redid the filling quickly blaming the bond. *To me* that sounds like [quoted text clipped - 29 lines] > >> CY Lingering pain for more than a few seconds with hot/cold usually indicates irreversible damage to the nerve and a need for root canal treatment. It's not very uncommon for this to occur after a deep filling... sometimes the use of the drill to clean deep tooth decay is the final insult to the nerve and it starts hurting. Your dentist should run some pulp vitality tests and decide on the need for root canal treatment accordingly. Regards, George I think this is true but this filling was not very deep, at least as far as the dentists have all told me. I belive they are doing the special tests on Friday. What to expect? TIA, CY > Lingering pain for more than a few seconds with hot/cold usually > indicates irreversible damage to the nerve and a need for root canal [quoted text clipped - 6 lines] > Regards, > George You need to find someone who knows what they are doing, numb up the tooth, remove *all* of the composite, use a bonding system like Clearfil SE bond (as directed!), and layer composite (using a little flowable composite as well) into the preparation with good curing between layers. Adjust the occlusion right the first time and you should be fine. BTW, a rubber dam should be in place for the whole affair. JME & O, D > I think this is true but this filling was not very deep, at least as far as > the dentists have all told me. I belive they are doing the special tests on > Friday. What to expect? > > TIA, > CY Do you use RD for just problem teeth or for all of your posterior restorations ? If for all you just going one tooth behind and one forward or going to the opposite cuspid ? >You need to find someone who knows what they are doing, numb up the >tooth, remove *all* of the composite, use a bonding system like [quoted text clipped - 15 lines] >> TIA, >> CY For me, RD use varies. Trying to fix a potential screw up, puts it in the 'mandatory' category. *My* other reasons for RD placement for operative procedures: Less than cooperative patients 'Big' tongues 'Curious' tongues Chubby cheeks Limited opening Over active salivary glands Quadrant preps Gaggy patients Patients that want to spit every 15 seconds Patients who talk *way* too much etc. Placement is sometimes one tooth (like for an occlusal on #18), but more often a quad (second molar clamped and isolated to cuspid on the same side). :-) D > Do you use RD for just problem teeth or for all of your posterior > restorations ? > > If for all you just going one tooth behind and one forward or > going to the opposite cuspid ? Yep, all good reasons. How about for endo ? <g> >For me, RD use varies. > [quoted text clipped - 27 lines] >> If for all you just going one tooth behind and one forward or >> going to the opposite cuspid ? You better have a '<g>' on there! D > Yep, all good reasons. > > How about for endo ? <g> After re-reading the Subject line, couldn't help myself. Didn't we have that discussion a few years back ? <hehe> >You better have a '<g>' on there! > [quoted text clipped - 3 lines] >> >> How about for endo ? <g> My root canals only lasted about 5 years then the teeth had to be extracted. Also, front teeth are poor candidates for this treatment. My advice would be to skip the root canal and go right to an implant. It should last a lifetime.You'll eventually need an implant anyway and why go through the proceedure twice. A couple of years ago an article in the AARP magazine said we would be able to grow a completely new set of teeth within 4 years, that being 2 years ago seems a coarse to investigate. Stem cell research will bring a new day to medicine and dentistry. > During my routine checkup I was told I needed fillings in two teeth that > are next to each other. [quoted text clipped - 33 lines] > > CY
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