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Medical Forum / General / Dentistry / January 2008Sensitivity after dental restoration
I had a good number of ancient fillings replaced a few months ago. I was told that I should expect sensitivity for up to several weeks afterwards (something about the caustic adhesives). However, now it is about three months later and they still flare up from time-to-time. A different dentist did full x-rays and said the restorations looked fine and there was no sign of any decay or bone loss. However, is it possible that the restoration work irreversibly damaged the pulp? How long do I wait until I decide something has to be done? Will they stay like this forever? Thanks for any guidance. > I had a good number of ancient fillings replaced a few months ago. I was > told that I should expect sensitivity for up to several weeks afterwards [quoted text clipped - 4 lines] > irreversibly damaged the pulp? How long do I wait until I decide something > has to be done? Will they stay like this forever? Thanks for any guidance. The responsible tooth or teeth should be identified. If these are resin fillings bonding technique is very important, and carelessness will lead to sensitivity. It may be necessary to change the fillings, but each time you put the drill on the tooth you increase the chances a root canal will become necessary, so your dentist will want to proceed carefully. Steve >> I had a good number of ancient fillings replaced a few months ago. I was >> told that I should expect sensitivity for up to several weeks afterwards [quoted text clipped - 13 lines] > >Steve All good points. The symptoms of irreversible pulpitis include Sensitivity to cold, and biting/chewing. Hot sensitivity, especially lingering is always a bad sign. ie. indicative of irreversible pulpitis resulting in the need for RCT. Time2time flare ups suggest a parafuntional habit or occlusal interference. < the "bite" may be a bit off > Irreversible pulpitis does not show on radiographs. It is almost always diagnosed by symptoms. >>> I had a good number of ancient fillings replaced a few months ago. I was >>> told that I should expect sensitivity for up to several weeks afterwards [quoted text clipped - 9 lines] >>> has to be done? Will they stay like this forever? Thanks for any >>> guidance. >> The responsible tooth or teeth should be identified. If these are >>resin fillings bonding technique is very important, and carelessness [quoted text clipped - 17 lines] > Irreversible pulpitis does not show on radiographs. > It is almost always diagnosed by symptoms. Thanks for the reply. The bite seems to be fine. How long can it take to get better if it is reversible pulpitis? Weeks, months, years? The dentist doesn't want to test the nerve yet since he said that could also aggravate the pulp. >> I had a good number of ancient fillings replaced a few months ago. I was >> told that I should expect sensitivity for up to several weeks afterwards [quoted text clipped - 15 lines] > you put the drill on the tooth you increase the chances a root canal will > become necessary, so your dentist will want to proceed carefully. Thanks for the tips. How do you tell if it is a carelessly done filling? Do I ask the dentist to try changing the filling based on the discomfort even though the x-rays seem to show the restorations are all good? > Thanks for the tips. How do you tell if it is a carelessly done filling? Do > I ask the dentist to try changing the filling based on the discomfort even > though the x-rays seem to show the restorations are all good? Unfortunately these kinds of symptoms in real life become diagnosed by exclusion--because the only way to really tell is to extract the tooth and examine it under the microscope. What is going on is inferred by symptoms and signs--just like alzheimer's disease, where looking for amyloid plaques in the brain is not practical. The nature of the pain is one way. Is is sensitive to cold? heat? Biting pressure? Does the tooth hurt spontaneously? Wake you up at night? Pain vary with your posture (upright/lying down)? The carelessness I alluded to had to do with the application of bonding agent. The conventional wisdom is that you must thoroughly soak all the dentinal surfaces, and then drive off the solvent completely before bonding. Leaving dentinal tubules uncovered by bonding agent is said to be responsible for sensitivity. Desensitizing toothpastes (BTW) work for a related reason--they cause crystallization of mineral salts in the dentinal tubules, thereby blocking them. This prevents movement of fluid through the tubules. We may find out someday that all of this is totally false, but this is the received wisdom of dentists now. Since I don't have a personal stake in placing resin fillings in back teeth (IOW, I have no problems using amalgam or resin in the proper situations), what I would do at this point is remove the filling, place a sedative dressing (I usually use something called IRM) and see if the symptoms improve. If they do, I am more likely to place an amalgam filling in this tooth, since the chances of postop sensitivity are lower. It still might be possible to place a resin filling, but I'd be extra careful, esp. since the IRM will contaminate the dentine with eugenol. I wouldn't make too much of the "carelessness" comment I made. This happens to everyone--and there's no way you can see that all the tubules are covered by bonding agent. But being aware of this problem, I ALWAYS place at least 3 or 4 coats of bonding agent, being careful to dry each coat thoroughly before applying the next coat. This keeps my postop sensitivity problems to a minimum--but certainly not to zero. BTW, I don't know how your dentist tests your pulp, but the common ways (cold or electric current) are neglegable risks to the pulp. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > Unfortunately these kinds of symptoms in real life become diagnosed by > exclusion--because the only way to really tell is to extract the tooth and [quoted text clipped - 13 lines] > through the tubules. > ... Thank you for the thoughtful analysys. I will certainly discuss the option with the new dentist. The original dentist, while very experienced, is not one that gives the impression of taking his time. If the tubules were not completely covered, does that mean the sensitivity will remain there forever, or will the tooth eventually make its own barrier? I assume the desensitizing toothpastes do not reach that far into the tooth? The flareups are created mostly by biting and cold. Not so much by heat. Thanks again. > Thank you for the thoughtful analysys. I will certainly discuss the option > with the new dentist. The original dentist, while very experienced, is not [quoted text clipped - 8 lines] > > Thanks again. Desensitizing treatments would not be expected to work well if at all. The sensitivity may remain or gradually diminish if the pulp is not damaged. Biting sensitivity calls for a careful evaluation of the bite. The cold sensitivity may be related to careless bonding technique; I'm not so sure about the biting sensitivity--it's less typical. Steve >> Thank you for the thoughtful analysys. I will certainly discuss the >> option [quoted text clipped - 18 lines] > sensitivity may be related to careless bonding technique; I'm not so sure > about the biting sensitivity--it's less typical. Yeah, it is wierd. Even flossing on the left side of the tooth causes a bit of discomfort. The tooth sort of feels "numb" in my mouth but clearly it has feeling. I'm sure an endo would tell me to get RCT but I don't want to do that on a hunch. btw - the bite has been deemed to be good by two different dentists. Well, I already learned a couple of things of value from you about the bonding and tubules. Thanks again. > I had a good number of ancient fillings replaced a few months ago. I was > told that I should expect sensitivity for up to several weeks afterwards [quoted text clipped - 4 lines] > irreversibly damaged the pulp? How long do I wait until I decide something > has to be done? Will they stay like this forever? Thanks for any guidance. robert, about 7 yrs ago i had a tooth root canaled and afterwards i had some heat, cold and pressure sensitivity in the tooth BELOW it which had been rc'd previously...endo testd both teeth w/ cold, and deemed both dead...been using prevident close to daily ever since and thought id be stuck w/ the senstivity, as over the yrs told other dentists but none could get to the bottom of it...after reading ur post i realized the sensitivity is GONE, THANKS! i havent thought of it probably in a matter of months, maybe even a yr! i think it subsided gradually...hopefully, worst case, urs will end up similar but hope u dont have to wait 7 yrs :) sherry On Jan 11, 4:26?pm, "Robert" <guyinc...@gmail.com> wrote: >> I had a good number of ancient fillings replaced a few months ago. I was >> told that I should expect sensitivity for up to several weeks afterwards [quoted text clipped - 9 lines] >> has to be done? Will they stay like this forever? Thanks for any >> guidance. > robert, about 7 yrs ago i had a tooth root canaled and afterwards i > had some heat, cold and pressure sensitivity in the tooth BELOW it [quoted text clipped - 6 lines] > subsided gradually...hopefully, worst case, urs will end up similar > but hope u dont have to wait 7 yrs :) sherry Thanks for the feedback, and I am glad to hear the sensitivity is gone. I'd like to think I had something to do with it :-) I haven't had root canal in the sensitive tooth, but I suspect I may eventually have to. Are you saying that you had sensitvity in a tooth that had already been canalled? (I thought root canal was supposed to deal with that.) many reasons. gum , bite etc If these semptoms are on the some level. Its rather nothing dengerous. How ever It needed to be check very precisely. I think Its a bite problem.. regards Kris-Polanowski DDS >I had a good number of ancient fillings replaced a few months ago. I was > told that I should expect sensitivity for up to several weeks afterwards [quoted text clipped - 7 lines] > irreversibly damaged the pulp? How long do I wait until I decide something > has to be done? Will they stay like this forever? Thanks for any guidance. Thanks for the feedback. Two different dentists said the bite is fine. My major concern is that the nerve was damaged beyond repair during the restoration. I guess I'll find that out eventually if it was. > many reasons. > gum , bite etc [quoted text clipped - 16 lines] >> has to be done? Will they stay like this forever? Thanks for any >> guidance. I was >>>told that I should expect sensitivity for up to several weeks afterwards >>>(something about the caustic adhesives). Very scary sentence. Good technique with good bonding systems should result in little, if any post-op sensitivity. :-( D |
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