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Medical Forum / General / Dentistry / May 2008

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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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