Medical Forum / General / Dentistry / May 2008
Filling pain - how long to subside before doing root canal?
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indigent@help.com - 27 May 2008 12:48 GMT Had a small cavity in #15, the dentist dug out the old amalgam (not too large and no cracks, according to him) and the tooth was filled with resin. No symptoms prior to this procedure. Severe pain/cold sensitivity for 5 days, he saw nothing on x-ray, said it surprised him since he wasn't working near the nerve, but he decided to redo the resin filling. Still extremely painful for days after - but since has started to subside (it's now been a week), where I can actually go for some hours at a time with no pain. Since it seems to be getting better slowly, should I wait it out? Or does pain/cold sensitivity a week out mean that it isn't going to get better and that I must go the root canal route?
Thanks for any feedback.
Dartos - 27 May 2008 14:18 GMT Lot's of things are possible, but unfortunately some dentists are still not proficient placing posterior composites. Poor selection of bonding materials or poor technique can lead to sensitivity issues.
Occlusion and clenching may also be issues.
JMO, D
> Had a small cavity in #15, the dentist dug out the old amalgam (not too large > and no cracks, according to him) and the tooth was filled with resin. No [quoted text clipped - 8 lines] > > Thanks for any feedback. Robert - 27 May 2008 16:45 GMT > Had a small cavity in #15, the dentist dug out the old amalgam (not too > large and no cracks, according to him) and the tooth was filled with [quoted text clipped - 9 lines] > must go the > root canal route? Depending on the skill of the dentist and your sensitivity to the materials it can take days, weeks or even months. I had discomfort in many resin filled teeth for months afterwards. Although "extremely painful" sounds a bit more concerning.
From what I've read, the materials used in resin fillings are much more caustic than those used in Amalgam fillings.
Personally, I already had a couple of resin fillings re-replaced with silver. I will never have another resin filling unless it is right up in front. Actually, I hope to never have another filling, period.
(I'm not a dentist, but I play one on TV)
Dartos - 27 May 2008 21:58 GMT Not bustin' your chops Richard, but that's all bull.
Composites should be *less* sensitive than amalgam and not even noticed after just a day or two.
Very deep restorations and clenchers can be problematic on occasion.
If the dentist that placed your composites was telling you this, it is a clear indication that he does not know much about the material.
JME, D
> Depending on the skill of the dentist and your sensitivity to the materials > it can take days, weeks or even months. I had discomfort in many resin [quoted text clipped - 9 lines] > > (I'm not a dentist, but I play one on TV) Robert - 27 May 2008 23:36 GMT > Not bustin' your chops Richard, but that's all bull. > [quoted text clipped - 5 lines] > If the dentist that placed your composites was telling you this, it > is a clear indication that he does not know much about the material. What you are telling me goes against what your collegues on this board have said. That the adhesives used in resin fillings are caustic and often cause discomfort especially if the practitioner has not been meticulous about it.
Also, more than one dentist has told me that composites last much less time than silver fillings. Considering that the main reason people get them is cosmetic, that is not surprising.
Steven Bornfeld - 28 May 2008 01:04 GMT >> Not bustin' your chops Richard, but that's all bull. >> [quoted text clipped - 13 lines] > than silver fillings. Considering that the main reason people get them is > cosmetic, that is not surprising. The assessment of risk has changed over time. The consensus now is that the greatest risk of sensitivity is due to incomplete coverage of the dentin by bonding agent, incomplete evaporation of the solvent, or inadequate bonding. Of course, when I was in school there was more evidence than you can shake a stick at that the treatment of dentin with phosphoric acid (the most commonly used etchant) caused pulpal cell death and microabscesses. There was copious microphotographic evidence of this. Somewhere between then and now, somehow this was all refuted. The proof is (as they say) in the pudding; I have no doubt that Steve Fawks indeed gets the results he says he does, and in fact I must say that (although I certainly still use amalgam) that my incidence of postop sensitivity with resin fillings is quite low. However, exactly how the phosphoric acid etchant went from being cytotoxic to being biocompatible--that I really cannot tell you! ;-)
Steve
Robert - 28 May 2008 01:30 GMT > The assessment of risk has changed over time. The consensus now is that > the greatest risk of sensitivity is due to incomplete coverage of the [quoted text clipped - 5 lines] > was copious microphotographic evidence of this. Somewhere between then > and now, somehow this was all refuted. The proof is (as Is the phosphoric acid used in the amalgam or composite fillings (or both)?
Anyway, why the great stampede away from silver? Was it mainly for the cosmetics, or were there other reasons? (Forgetting about the mercury alarmists.) What about the claims of at least two dentists I know that silver fillings last longer and leak less?
Steven Bornfeld - 28 May 2008 04:01 GMT >> The assessment of risk has changed over time. The consensus now is that >> the greatest risk of sensitivity is due to incomplete coverage of the [quoted text clipped - 12 lines] > alarmists.) What about the claims of at least two dentists I know that > silver fillings last longer and leak less? Resin has used acid-etching as far back as the mid 1950s (Buonocore)--a decade before the first commercially available composite resin (I believe that was Adaptic, made by J&J). Bonding agents I think came in maybe in the 1970s--back when the only photoactivated resin was the Nuva system--and that used UV rather than visible light. Parkell at one point claimed you can bond amalgam, but I don't think I've ever heard anyone else make that claim. When I was in dental school (1973-76) we did NOT bond our composites. Unbonded composites, and esp. those self-cure resins generally available back then leaked very badly--far worse than amalgam. However, I would guess that modern composite resins properly bonded probably leak less than do amalgams for the most part. I don't have the confidence that Dartos does about very large resins, because I have had some problems with them. That may well be me rather than a failure of the material. There is no doubt that as a restorative material, amalgam is closer to being idiot proof. What that means about me I'll leave to others to speculate.
Steve
Dartos - 28 May 2008 20:58 GMT > Anyway, why the great stampede away from silver? Was it mainly for the > cosmetics, or were there other reasons? (Forgetting about the mercury > alarmists.) What about the claims of at least two dentists I know that > silver fillings last longer and leak less? First, ALL restorative materials leak to a certain extent. Amalgam leaks like a sieve. After the gap between the amalgam and the tooth fill with corrosion products, it leaks less than when it was first placed.
Composite actually bonds to tooth structure. Amalgam does not. Properly placed composites absolutely leak less than amalgam.
Claims of superior longevity for any restorative material are often judgement calls. It also matters who did the work, and with what materials/technique.
It is a little more work, and a little more demanding to place a good posterior composite. However, most of the important issues are also important for a well done amalgam (i.e.-adequate decay removal, uncontaminated tooth surfaces, and quality materials used according to directions).
Cutting corners compromises quality of any dental work. Amalgam can be more forgiving for sloppy technique, but that is really no excuse to not be just as particular with amalgam as with composite.
I've been placing posterior composites since 1984. I have had excellent retention and longevity with the material. I would place my restoration success against their amalgams any day of the week.
As far as stampeding away from amalgam, I admit to being an early convert to composites, but it was mainly from patient preference. I would spend 10 minutes explaining the *honest* differences between the materials, and then the patient would say, "I want the one that looks like my tooth".
Sure, there were a few who said, "I don't care", but not many. I just decided to quit wasting an hour a day when patients either preferred composite, or didn't care either way.
Then it's just a matter of being good at what you do.
JMO, D
John & Ninetta - 28 May 2008 01:49 GMT <Snip>
> The assessment of risk has changed over time. The consensus now is that > the greatest risk of sensitivity is due to incomplete coverage of the [quoted text clipped - 12 lines] > > Steve I believe Hillary Clinton was about to tell us, but stuck her foot in her mouth with that Robert Kennedy comment.
John
Steven Bornfeld - 28 May 2008 04:02 GMT > <Snip> >> The assessment of risk has changed over time. The consensus now is that [quoted text clipped - 18 lines] > > John Paging Hans Blix!
Robert - 28 May 2008 02:05 GMT Came across this article from last year: http://jada.ada.org/cgi/content/abstract/138/6/775
Not night and day, but according to this somewhat better filling longevity for amalgam.
Steven Bornfeld - 28 May 2008 04:04 GMT > Came across this article from last year: > http://jada.ada.org/cgi/content/abstract/138/6/775 > > Not night and day, but according to this somewhat better filling longevity > for amalgam. Well, that shows roughly 3X the failure rate for composites. But I'll bet they weren't Dartos's composites!
Steve
ahuangdds2@gmail.com - 28 May 2008 17:37 GMT On May 27, 6:48 am, indig...@help.com wrote:
> Had a small cavity in #15, the dentist dug out the old amalgam (not too large > and no cracks, according to him) and the tooth was filled with resin. No [quoted text clipped - 8 lines] > > Thanks for any feedback. Every dentist will have their own view about Amalgam vs Composite. I'll wait a few weeks or even months before doing anything else. In my experience.....Post-operative discomfort happen with both amalgam and resin. It happen more on lower molars than any other teeth. If your filling is still new......Wait. Many patient will have no symptoms after 2-3 months, and they don't need root canal. But some do turn into root canal......
indigent@help.com - 29 May 2008 13:49 GMT >On May 27, 6:48 am, indig...@help.com wrote: >> Had a small cavity in #15, the dentist dug out the old amalgam (not too large [quoted text clipped - 17 lines] >after 2-3 months, and they don't need root canal. But some do turn >into root canal...... Thanks to all for all the great feedback. While still quite uncomfortable at times, the duration and severity of the pain is definitely subsiding, albeit more slowly than I'd prefer. :-)
So, even though the dentist said I needed root canal (based solely on it still hurting) when I saw him on Tuesday, I will indeed wait it out and see what happens. I can always get in quickly if the pain starts increasing, or otherwise indicates a worsening of the situation.
Steven Fawks - 30 May 2008 03:17 GMT If it doesn't get better, I would consider consulting a different dentist. If the cavity was truly not close to the pulp, there should not be this type of pain.
JMO, Steve
> So, even though the dentist said I needed root canal (based solely on it still > hurting) when I saw him on Tuesday, I will indeed wait it out and see what > happens. I can always get in quickly if the pain starts increasing, or otherwise > indicates a worsening of the situation. ahuangdds2@gmail.com - 30 May 2008 15:35 GMT On May 29, 7:49 am, indig...@help.com wrote:
> On Wed, 28 May 2008 09:37:17 -0700 (PDT), "ahuangd...@gmail.com" > [quoted text clipped - 31 lines] > > - Show quoted text - Agree with Steve
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