Filling replacement

[MountainMama]

I’m back. I have gone several years with just a few flare ups from atypical facial pain, and have had zero dental issues in the past five years. I won’t go into my whole story, as I have tons of posts but short story is I have atypical facial pain, had multiple molars extracted before it was figured out, and any dental work triggers my nerve issues. So filling replacement becomes root canal or crown, which leads to extraction due to terrible lingering pain.

We have moved in the past few years and I have a new dentist who is unfamiliar with my history. I have explained it. I have luckily had no dental issues since moving here up to now. I have a 20+ year old amalgam filling that has been failing for awhile. It has given me pain off and on but I put it off due to the fear of it triggering my nerve issues and escalating to an extraction. The dentist told me at my appointment last week that the filling has to be replaced as there is decay (likely quite a bit) and the filling is loose.

Given my history I am worried about it escalating again. This tooth is an upper right first molar (#3), and the tooth hurts when biting and generally aches mildly off and on but not consistently. I am on gabapentin for the AFP.

Most of my prior issues were on lower teeth. Are upper teeth just as likely to be impacted by the TMJ or nerves?

I am working full time and can’t afford to miss a bunch of work due to dental work.

 

[Gordon]

Are upper teeth just as likely to be impacted by the TMJ or nerves?

A bit, but possibly less. The nerve stuff is tricky, you've got a much more diffuse nerve supply to an upper first molar, so there are more nerves to mess about with, but the actual injection itself is probably less likely to stir things up. An IDB is a bit more invasive and can cause more local inflammation.
TMJ wise, the IDB for the lower is closer to the joint and associated nerves than for the upper molar, so probably less chance of that stirring things up, but if it's a big filling with the chance of taking a long time then that's less good.

So long rambling answer to say it might be OK or it might not. AFP is so poorly understood there aren't any certainties here, sorry.

 

[MountainMama]

@Gordon that is okay. Thank you for the reply. I am crossing my fingers and praying for a good result. The filling is large to me, but the dentist said he didn’t think it would be a big deal. It goes down the side of my tooth and middle of the back cusp. The tooth actually has two amalgam fillings, a small one in the front of the tooth and the larger one in the back inner part (the one that needs replacing). He is only going to redo the back one as it is the one hurting.

 

[MountainMama]

@Gordon This was the first painless dental appointment I have ever had! I have been with this dentist for several years now but haven’t had anything other than cleanings until now. He even gave a shot that wasn’t that bad. He said the decay was really deep but I wouldn’t have even known. The numbing is wearing off and so far so good. I did take a gabapentin once I got home.

 

[Gordon]

That's great to read. Thanks for the update and I hope it continues to go smoothly for you.

 

[MountainMama]

@Gordon I am getting some sensitivity to touch and some minor twinges today with a few painful zings occasionally. I hope they settle soon. It is making me nervous. I took another gabapentin once I got home from work.
My nightguard does not fit anymore though. I forgot to bring it to the appointment. I will have to wait until Tuesday to call as we have a holiday Monday and the office wasn’t open today.

 

[MountainMama]

@Gordon When should I call the dentist if my tooth that had the filling replaced is still hurting. It was getting better and now is sensitive to touch (not pressure on the tooth), and has little pulses of pain. I don’t want to panic as I know it can take a few weeks to settle, especially given my condition. I have been taking my gabapentin but as soon as it wears off the pain comes back. It is not horrific pain, just a pulsing ache and occasional jolts. It is getting more sensitive, like if I run my tongue over it I get a little jolt.
Right now it has a week and two days since the filling was replaced.

 

[Gordon]

It's probably worth asking them to take a look, might just need the bite adjusted slightly on the new filling (especially if it's a composite one).

 

[MountainMama]

@Gordon thank you! I will call them. They did check my bite with carbon paper and I went back in for them to adjust my nightguard. Hopefully it is just a bite issue. The filling was in two places, one in the back center and one on the back inner side.

 

[Gordon]

It can be hard to zero in the bite when the patient is numb, so another quick check when you aren't numb isn't a bad idea.

 

[MountainMama]

I did go back in. My bite was perfect, and the dentist said there were not enough symptoms to diagnose but it was possible that the nerve was dying. He said that typically the pain happens right away not weeks later but it could also just be acting up and not settled. It didn’t hurt with percussion and no pain with palpating the gums.
Since then, it has been back and forth. It will go a few days with no pain then pulse for a few hours. It is weird. I hope it settles since it is not consistent anymore.

 

[Gordon]

Thanks for the update. Best I can do is keep my fingers crossed for you