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Medical Forum / General / Dentistry / December 2007

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Tooth pain

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chrisbet@tiscali.co.uk - 17 Dec 2007 19:51 GMT
Can someone help please?
1. I have a rear lower molar which gave me no trouble until 18 months
ago when my dentist filled it.  Since then it hurts when pressure is
applied (e.g. chewing) - but only to the center of the rear of the
filing itself.
2. I can bite really hard on the raised edges of the tooth (e.g.
eating steak or biting heavily on a flat plastic block) with no pain
or problem whatever.  But if I eat something that fills the hollow of
the tooth and the one above (e.g. crisps) then I only have to bite
gently and there is consideble pain.
3. Similarly, if i bite something hard and small (like a small nut or
fruit and fibre flakes) then these tend to hit the sore spot and again
really hurt.
4. If I press all over the tooth witha plastic pen top its all fine -
appart from the small spot on the filling itself.  I only have to push
on that very gently to make it hurt.
5. The filling is a white one and it replaced a previous amalgam one
(which had given me no trouble).
6. My dentist says it is not a deep filling (but it originally
extended to three sides of the tooth) and he cannot work out what the
problem is.
7. My dentist removed part of the filling and replaced it - and
extended it to the top of fouth side of the tooth (effecively removing
the rear top quarter of the tooth) - but that did not help.
8. At my last visit he tried shamfering the back corner of the tooth
to see if that helped - but it has not.
9.  He says that the nest approach is probably a root canal - but I am
reluctant to go through that if there is a simpler explanation - so I
continue to chew offending items on my other side.
It just seems odd to me that it gave me no trouble before the fling -
and that the pain is limited to one small tender area on the filling
itself - with the surrounding tooth standing up to all sorts of heavy
pressure with no problem at all.
Has anyone got any ideas please?
Thanks, Chris
George - 17 Dec 2007 20:30 GMT
Although you have gone into great detail describing your problem, it's
really hard to say what the problem here is. If as you say the problem
is located only on one spot, I don't think I would suggest root canal
treatment... for the time being. They way you describe the problem, it
sounds like failure of the bonding agent, especially if the pain is
triggered when you release the pressure. I don't want to get very
technical, but sometimes this happens and especially with fillings
that could be considered small and it can be very frustrating for both
the patient and the dentist (well, I imagine it's more frustrating for
the patient!).
If I had a patient describing such symptoms to me, I would probably
remove the entire filling, making sure that I got all of it out since
white fillings can be pain to discern from natural tooth substance.
Then I would place a temporary restoration, probably glass ionomer,
and I would leave that for a few weeks for the patient to try. If the
symptoms disappear, it is very easy to cut back the glass ionomer
material, leave some at the bottom as a base and fill the rest with
white resin.
Of course your specific circumstances may dictate a different
approach; the only person that can tell is your dentist.

Regards,
George
chrisbet@tiscali.co.uk - 18 Dec 2007 00:19 GMT
> Although you have gone into great detail describing your problem, it's
> really hard to say what the problem here is. If as you say the problem
[quoted text clipped - 19 lines]
> Regards,
> George

George

Thank for the very helpful and speedy response.  It never occurred to
me to think about this but you are right - the pain comes on releasing
the pressure rather than applying it.  I will summon up the courage to
vist the dentist again and suggest he replaces the filing as you
suggest.

Thanks very much for your reply.

Regards, Chris
George - 18 Dec 2007 18:36 GMT
On Dec 18, 12:19 am, chris...@tiscali.co.uk wrote:

> > Although you have gone into great detail describing your problem, it's
> > really hard to say what the problem here is. If as you say the problem
[quoted text clipped - 31 lines]
>
> Regards, Chris

I forgot to mention that pain on release may also indicate a cracked
cusp, which is more difficult to address and may require covering the
tooth with a crown.
I wish you all the best.

Regards,
George
chrisbet@tiscali.co.uk - 19 Dec 2007 23:32 GMT
> On Dec 18, 12:19 am, chris...@tiscali.co.uk wrote:
>
[quoted text clipped - 43 lines]
>
> - Show quoted text -

George

Thanks for the further advice and for your good wishes.  I will bear
this in mind.  Because of the way I can bite hard on the 4 corners (I
believe these are the cusps) and the sides of the top of the tooth
with no problem I am hoping the problem is the filling.  Anyway -
thanks again for the help - it is very much apreciated.  I feel a lot
better about going to see my dentist again now I have some alternative
ideas.

Regards, Chris
 
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