Is it safe to get a filling on a sprained tooth?

[Anne2023]

I had a very small cavity that my dentist and I were watching last summer. Due to a snowstorm that caused a canceled check-up, I didn't get it rechecked when intended. Now I'm noticing pain when I floss and I can see the progress of the cavity. I see the dentist in the morning and I'm hoping it just needs a filling.

I also suspect that this tooth is "sprained." There is a soreness sort of pain when I bite on it. The symptoms fit from what I've read. The back story is that I have been chewing "wrong" for the last three months, and I believe this tooth is reacting to that. It's tooth #10. I have no lower molars and I had an incident with my partial denture three months ago, where it accidentally ended up in the trash. I figured it out before taking the trash out, but I haven't been able to get past the fact that it was in the trash with other disgusting things to the point of putting it back in my mouth. So I've been eating with just incisors and canines and one set of occluding bicuspids on the right side for the last three months. I have been as careful as possible to not stress the teeth with very hard things, but my chewing has not been proper or normal.

I know the dentist will evaluate things tomorrow, but I'm nervous about working on the tooth in this condition. If the tooth is "sprained", could drilling for a filling do it further damage in that condition that might result in causing the need for a root canal or extraction? Should a filling be delayed until symptoms related to the sprain resolve?

 

[Gordon]

If the tooth is "sprained", could drilling for a filling do it further damage in that condition that might result in causing the need for a root canal or extraction?

No, not a chance. It's absolutely fine to fill it if it needs doing.

 

[Anne2023]

Thank you so much for your reply, Gordon. I had gone ahead and gotten the filling two weeks ago; however, I am still having a problem in that area.

Before I get into that, regarding the suspected sprain, I asked yesterday and the dentist showed me the x-ray where #10 and #11 appear to have a widened or inflamed periodontal ligament. She didn't mention it when she took the x-ray two weeks ago, but when I asked about possible sprain, she showed me and asked if I grind my teeth. She also said my bite is "end to end". Grinding is possible, but I was also eating without my lower partial for three months when I accidentally tossed in the trash for more than a day before I found it there. She convinced me that she was able to clean it in the office to a level that I should not be concerned about germs, so I am using it again. During the time without it though, I had no occlusion with my one remaining upper molar and pre-molar on my left side, and pre-molar #12 is gone (extracted six years ago) with an empty space there, so any attempt to chew on the left side was all on #10 and #11 and no support next to the gap where #12 had been. I had been allowing chewing on them since I also had no occlusion with molars on the right side though the right pre-molars are still there. Is there hope that the sprained tooth/inflamed periodontal ligaments can heal? I have what I would call a "soreness" type of pain when I bite on it and when my other teeth tap it from the side while talking or chewing. I first noticed the pain two and a half weeks ago. I've been wearing the partial again and trying not to stress those teeth for two weeks now. The pain is still the same when I unintentionally contact it. The dentist didn't suspect a crack, but she didn't really go into healing or possible problems in the future, except to ask about grinding. If it doesn't heal, will the teeth loosen or the nerves die? Any advice here would be appreciated.

As to the filling in #10, she filled it with a composite. She called it mesial facial. It was on the side that touches #9 in about the middle of the length of the tooth. Originally, before the filling, I noticed that when I flossed there, the friction of the floss hurt. I knew there had been a tiny area of decay there that we were watching. It now appeared larger and I could see it better. She got me in and did the filling two weeks ago. My phobia sometimes extends to even avoiding brushing or flossing when something is going on, so I did not floss between those two teeth right away. A week after the filling, I was flossing and without thinking about it, I flossed there. It hurt like before. I checked the mirror more closely and there was a small brown area. There was also an obvious area at the top of where the filling was placed, where the floss was catching. I believe that is where it hurt the most, when the floss hit that spot. I was still pretty nervous about everything and it took me a week to call her office.

I called yesterday and reported the symptom and she saw me yesterday. Right away she said she could see a "void" in the filling. She said it was her fault. She also mentioned a "ledge", which I believe is the area where the floss was catching and hurting. I was surprised that she didn't say the filling needed to be redone. She said she could fix it. She offered local anesthetic, but I went without since it wasn't going to be a long or involved procedure, so I was able to feel everything normally while there. She fixed the void first. I don't know what all she did, but she did say she was adding composite. Then she said she would fix the ledge. It seemed to me that she just sanded it down. She inserted some sort of tape, I think and that was the part of the work she did that hurt. Then she ran floss through it. Then she polished it. When she flossed, it hurt in the area she was working on and I told her. She seemed surprised. Then she focused higher on the tooth and suggested that the root might have some exposure and that is where the flossing hurts. She asked if I look in the mirror when I floss. I usually do. I know where I'm flossing and which area hurts. I think she was hoping that I was just mistaken about which area is the source of the pain. I asked her if there should be any pain going forward and she said, no. I waited until this morning to floss between those two teeth and in that area and the friction of the floss hurts. It's a lot like before, except that I can't see an area of decay or ledge; it just hurts where the floss touches the area where the filling was placed.

I'm now struggling with where things stand and where to go from here. From the information I'm able to provide, does it make sense that she would have just "fixed" the flawed filling and not replaced it? Does sanding down the ledge make sense? If it's still hurting with friction now, when she said it shouldn't, is there any reason to think it will get better? Should I be seeing a different dentist ASAP to get an opinion on what is happening? Any thoughts or advice beyond the questions I can think of would also be much appreciated.

Thank you!

 

[Gordon]

If it doesn't heal, will the teeth loosen or the nerves die? Any advice here would be appreciated.

It should be better now that you've put the partial back in. It's very unlikely that it won't, so try not to worry about it.

The void will have been a small air bubble in the composite, no biggie, it happens occasionally and it's easy to fix.
If there was a ledge then yes, sanding it down is the appropriate treatment, replacing the whole filling is overkill and would result in loss of a little bit more tooth structure, so best avoided.

If there has been a bit of gum recession in the area then it would be a bit tender to floss. You can try a DIY approach to fix it, carefully massage in some sensitive tooth toothpaste into the area last thing at night and leave it there to work overnight.

Give that a week or so, if it doesn't fix it get back onto the dentist, we have more potent stuff to desensitise but most of them taste awful, so I'd always try the DIY fix first!

 

[Anne2023]

@Gordon Thank you.

 

[Anne2023]

@Gordon I'm still having issues with the same tooth (#10) and I'm afraid that I'm getting more panicked all the time. I had set up an appointment with the same dentist the last time I was there to fill #7 this coming Monday. #7 has a cavity very similar and in the same place on the tooth as the filling done on #10 in May. I'm struggling with whether to keep the appointment or not. I have a hard time going to the dentist at all and building trust so that I can keep going. I have only had one other filling by this dentist and have only been with her a little over a year. I keep wondering about whether the void and the ledge that happened with the last filling indicate that I shouldn't trust her work. I know you said that the void is something that can happen, but I'm concerned that the ledge and more especially, the fact that there were two things wrong with the filling, should be a warning sign to me to find someone else. Should I be seeing the errors with the filling as a red flag?

I've only flossed next to the filling twice since the fixes she did. It didn't hurt like it did after the filling three weeks ago, but it still doesn't feel like I would expect. Like it's still sensitive to the friction.

I am concerned as well that the area up near the gum line now feels much larger, like the floss slips over a ledge up there now. I don't ever remember that being there before. The only thing I noticed at the gum line previously was a little zing occasionally when the toothbrush bristle would catch it a certain way. If there's a ledge up there that I can pull the floss over, doesn't that need a filling?

The soreness from the "sprain" continues. I avoid it, but when I accidentally touch it while eating, I can tell it's not healed. I had done a little test pushing on it with another tooth and with my finger on the other side of it - just once back after the filling was placed - to see if it was loose, and it does have more give than my other teeth. Is there anything I can do? Do I need to put a single false tooth in the gap left by missing #12 to shore things up?

Between the original problems with the filling, the sprain and "give" in it, and the newly discovered ledge at the gum line, I'm panicking about losing this tooth and am completely bewildered about whether to trust this dentist to fill #7. Any advice is much appreciated.

 

[Gordon]

Since it seems you've lost confidence in this dentist, it might be worth trying somebody else for a second opinion at least.
I really can't help much with the symptoms, there are a load of things it could be, but can't really diagnose without getting "hands on".

 

[Anne2023]

@Gordon Thank you for your reply.

A big part of my struggle is that I have lost confidence in multiple dentists before her and any wrinkle or issue can easily send me down that path to looking for a new dentist, which I why I haven't been with her for long. I can't separate what is my phobia and trust issues vs. what is objectively a good reason to question someone's competence to treat.

If I were to narrow it down to just my experience with the filling on #10 - where there were two problems with the filling - the void and the ledge - on what did not appear to be a complex situation - would that give you pause to question whether I should let her work on another tooth?

I just don't know where to go next and as scared as I am to proceed, I'm also scared to give the cavity on #7 more time to grow, as getting set up with yet another new dentist often takes quite a bit of time to get in.

 

[Gordon]

I wouldn't worry over much about the cavity growing larger, unless your diet is pretty bad then it should be fairly stable for a few months.
Can't really comment on the dentist's work, anyone can have a less than optimal result, especially doing composite filings, they can be quite tricky.

 

[Anne2023]

@Gordon Thank you again.

I cancelled the appointment for the filling yesterday. I had my regular cleaning and check-up scheduled with the same dentist for next week. I figured I will go and try to discuss the issues to see what she thinks. I especially want to ask about the area near the gum line and if she did something that I am unaware of that created the ledge that the floss is now slipping over. I will tell her I don't want any work actually done. Does that seem reasonable?

I also made an appointment with a dentist at the faculty practice of the dental college at the university here for a second opinion. He can see me in two weeks.

 

[Gordon]

I will tell her I don't want any work actually done. Does that seem reasonable?

Yes, seems perfectly OK to me.

 

[Anne2023]

I went to my dentist for the cleaning and exam three weeks ago. She didn’t say much about tooth #10 and the filling she placed. She seems satisfied with it. Then when she looked at my x-rays, the hygienist was standing next to her and they both looked and acted shocked at how deep the cavity on #7 is. Eleven months before, it wasn’t even noted to watch it. I was the one who pointed out a small brown area that looked like decay in May. It doesn’t hurt to floss it or eat. It isn’t temperature-sensitive. I looked at the x-ray with them, and I think I saw what they were pointing out, but I’m bewildered. Then she scheduled me for a filling in nine weeks from that day (six weeks from now).

So I went to the university two weeks ago to get a second opinion on both teeth from a professor who also practices at the faculty practice. When the person who was assisting took the x-rays, she paused and said she wanted to take another one because of what she saw on the first one. The area she did a second time was the area with #7. The dentist, however, saw nothing. Throughout the course of the appointment, I asked him two more times. He knew he was giving a second opinion, and I told him the previous dentist thought it needed a filling, and he insisted it didn’t need anything, not even the little brown area that I can see.

I asked him about #10 and explained the history of the filling and the repair to the filling and the ledge, etc. He examined it near the beginning of the appointment and then again at the end. (I was there quite a while. He was very talkative and talked a lot about a lot of subjects and dentistry in general). On at least 4-5 separate occasions, he pulled downward on the ledge with floss. It hurt every time and I told him so. The discouraging thing is that since that day, now when cold air passes over that tooth, there is pain. It’s not severe, but it is pain. I don’t think that happened before I saw him. (I had been very gentle flossing up to that point and attempted to avoid the ledge). I don’t think it’s sensitive to cold food or drink right now. He seem noncommittal as to an opinion about the filling. He mentioned possibly needing the filling redone at some point (I think he said if it bothers me).

I asked him based on that filling only, would he not recommend the dentist who did it. He didn’t ring in with a clear answer either way. Then he made a comment about the filling on #29. I said she also did that one and asked if it looked good. He didn’t answer the question and we were near the end of the appointment, so I dropped it.

He definitely did not increase my trust in the dentist I have been seeing. Yet after the reactions of the previous dentist, her hygienist, and the assistant at the university, I don’t see how I can dismiss what might be going on with #7. Do you see any reasonable path other than a third opinion?

Any thoughts or reactions are much appreciated.

 

[Gordon]

Can you post the x-rays?

 

[Anne2023]

@Gordon Thank you for your reply. I had already made an appointment for the third opinion before your response came in. When I saw your question about the x-rays, I called the university faculty practice (dentist #2) and asked about getting the ones taken that day, and they said that they will not release them to me - only to another dentist. I thought about contacting dentist #1 and asking, but I felt very awkward about it and thought it might affect the relationship if I end up going back there. It's a very small office with just the one dentist. While contemplating making that call, I decided to keep the appointment for the third opinion, which was today.

Dentist #3 is also a faculty member and teaches at the university like dentist #2, but he has his own practice away from the university. His assistant took x-rays and he did his examination. As far as #7 goes, he says it is a small cavity. He thinks it does need to be filled, unlike dentist #2, but it's small enough that it could possibly be done without anesthetic (I mentioned my fear of the anesthetic and numb feeling). I told him about dentist #1 and her diagnosis of a deep cavity. He said that it can be the angle of the x-ray and I think, the angle of the tooth, that creates an x-ray that can appear misleading. He said that it's clear from examination of the tooth that it's not deep.

He checked out the filling on #10, including taking an x-ray. He ran his tool over the ledge a bit. When he flossed it, it didn't hurt, but he didn't "yank" on it like dentist #2 did. It seemed to shred the floss. I admit that I have been avoiding flossing it myself because of the issues with it. He asked if it was sensitive to cold or heat. The way he said it made me concerned - like he expected me to say yes after examining it. I said that it wasn't before all of this, but now it is sensitive to cold. I've been thinking that started after dentist #2 checked it out and "touched" it so much, but now I'm not sure it didn't start before that. I know it wasn't sensitive before the filling. He said sometimes getting the filling can rile the nerve up for a time, but I don't know what to think. It has been more than two months since getting the filling. He didn't think it needed to be replaced at this time. I asked if he would trust the dentist who placed it. His first response was to ask if they charged me to repair the void and file down the original ledge. I said no, which he thought was good. Then I specified if he would trust the dentist's technical competence. He said he would think that the dentist should have noticed the problems with the filling before letting me leave the day it was placed. He didn't say more than that, but from his response on this and his reaction to dentist #1 thinking that #7 was a deep cavity, even after examining the tooth, I don't think he would recommend going back to her.

I will not be going back to dentist #1. I'm thinking about asking them for all of my x-rays, since I won't have to be concerned with damaging the relationship. Right now, I'm stressed about how much tooth structure she took from #10. I have taken a good look at the filling using a flashlight to see a clear distinction between the composite filling and the tooth. Even before getting second and third opinions, I was surprised at how big the filling is. I even mentioned it to her the day she fixed it, and she just sort of smiled and nodded like it was a big cavity. Now that I know she is wrong about #7, I'm kicking myself for letting her work on me. I would like to see my x-rays before and see what they look like. I don't think the cavity on #10 was much bigger than #7 is. It had just started to hurt a little when the floss rubbed up against it. That's why I went in.

Now I'm trying to decide whether or not to let dentist #3 fill tooth #7. This is a major setback for me pushing through the phobia.