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Pain with biting after filling

A

Anne2023

Member
Joined
Dec 15, 2023
Messages
21
Location
USA
I had a deep composite filling placed in my lower right canine (#27) on Wednesday, April 3. The receipt says it was facial, mesial, lingual. I could see the decay in the front and side where it abuts #26 before getting the filling. I had sensitivity to cold and was starting to have sensitivity to hot when I went in for the filling. There was no sensitivity to pressure or biting before the filling.

The dentist knew that it was deep, but she said when she got in to do the filing, it wasn’t any worse than she expected it to be. I had no pain, but I took a little ibuprofen off and on for a few days after preventively since I was afraid the drilling might have riled up the nerve. I babied it for a week or so after and avoided it. Once I started trying to eat normally and not avoid it, I noticed pain when biting down on a potato chip. I avoided it again for a day or two. I tried potato chips again and sure enough it hurt again. I also noticed pain today eating a softer stew, but I didn’t have my partial in that time. (I have a lower partial that I only wear sometimes). I haven’t noticed pain when eating things that aren’t harder like the chips when my partial is in. Any temperature sensitivity is no worse than before.

It has now been 18 days. I am dreading calling my dentist for fear that the tooth is dying and I don’t want to go in and get the bad news. I am also supposed to get another filling in three and a half weeks and I’m terrified to do that one now. It is #29 and my partial attaches to it. I’m so scared to rile that one up and have it end up dying.

Is there any hope for this tooth (#27) without a root canal?
 
It might just need the bite adjusting a little bit. Get the dentist to look at it again.
 
@Gordon Thank you for your reply.

I did some searching on this site yesterday afternoon and found a post that you had commented on. Is it possible that it could be what you discussed there - and might need one of the fixes you listed?

 
Yes it could be, but it needs a hands on check by your dentist to see what's going on. Don't leave it any longer.
 
Thank you, Gordon.

I called this morning and she can see me tomorrow afternoon.
 
@Gordon I went to the dentist five days ago, and I'm struggling with whether I should stay with her. The filling was down toward the gum line, so it isn't a bite issue. She took an x-ray and examined it. She tapped it, and had me bite down on a plastic stick of some kind with it and the neighboring teeth (I think) over ten times in different places. It was tender/caused pain once - probably a three on a scale of 1 to 10 and no lasting pain. She showed me the x-ray, and I was taken aback. What is worse is that the look on her face showed surprise, which has me concerned. On the original x-ray, there didn't appear to be much space between the cavity and the nerve chamber. We knew it would be deep. The day of the filling, she said that when she got in to do the work, it was not worse than what she expected. The x-ray from last week shows no space between the filling and the nerve chamber. It is right up to it. The look on her face spooked me and then she just started talking about how what looked like space between the cavity and the nerve on the pre-filling x-ray was actually also decay. If that's true, and if she said that it wasn't worse than she expected when she did it, why wouldn't she have known that before she started the work? Then she said that maybe the tooth will make dentin to wall itself off. And maybe not. So the nerve may die.

I have two more fillings that I am supposed to get in two weeks, and I just don't know whether to stay with her or not. One cavity (on #29) is probably moderate and has decay under/around a previous filling and the other one (on #28) is small. My previous dentist retired at the end of 2021, and this one has done three fillings for me now - all deep. The other two continue to be temperature sensitive. When she did the first two (13 and 14) at the same time a year ago, I asked if she would be doing anything like DyCal (calcium hydroxide). My previous dentist - who was in the same office before he retired - had explained to me a few years before when doing a deep filling, that he would use DyCal because it was so close to the nerve. (That tooth - #12 - ended up dead and abscessed almost two years later). When I asked her if she would use DyCal, she said no. When I asked if she would use something else but like it or with the same purpose, she said no. I have no reason to think she would have used it this time. I've read posts here and looked around online and it seems fairly common to use something like that to help with healing and long-term survival when placing a deep filling. She is not saying that the next one is as deep, but I know it is not small. It is #29 - and 30 and 31 are gone - and my partial attaches to #29. I really, really don't want to lose it. I have already lost 8 teeth in addition to my wisdom teeth. Now I'm doubting her on account of 1) why would a dentist not use a material that would help a tooth with a deep filling to heal/survive, and 2) is she just really aggressive with drilling out decay and went deeper than she needed to go on #27 (based on the original x-ray and her own surprise when seeing the new x-ray)?

It has been so hard to find a new dentist after having one I trusted and I can't figure out whether to trust her or not. I don't want to lose teeth if her technical practices are not what's best for tooth survival. I'm finally ready in terms of not looking for excuses to delay work until things get worse, but I don't trust her.

Also, the previous filling on #29 is glass ionomer because it is down by the gum line. I asked her if she would use glass ionomer and she said she would prefer to use composite if she can make it work for cosmetic reasons. I told her I don't care about that if glass ionomer would work better.

I'm also wondering about why the filling on #27 had to go so deep because I got a second opinion from a very conservative dentist a week before she did the feeling. That dentist had refused to do the one on #12 a few years ago when I was looking for a dentist then (before I decided on my previous dentist). He thought that one (12) was too deep to do without a root canal, but he was fine with doing #27 without a root canal so it can't have looked as bad to him. From past x-rays, the filling on #12 did not appear to end up as deep as the one on #27 - so I am really doubting her and why this ended up so close to the nerve. I'm up against the wall with decisions to make on where to get this work done and whether to cancel the appointment two weeks from now and look for someone else. It's really got me wondering, are some dentists just more aggressive about removing tooth structure once they get in to the tooth?
 
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I'm not sure what you're asking me here?

Dycal is pretty much considered obsolete now, the high alkalinity long term seems to be more damaging than helpful. These days we seal off the pulp with a material like bonding resin.

Composite is a better material than glass ionomer if it's near the gum margin, GI is quite rough microscopically, which is good for plaque growth, you can get a composite far smoother.
You can never tell from an x-ray how much decay is in a cavity, they simply aren't that sensitive.
 
I'm sorry I disappeared and did not respond. My mother passed away the day that you replied, and I let my dental concerns go the last few weeks.

Thank you for your reply. You did a good job of finding my questions buried in a much-too-long post. I guess I'm just wondering if there is a way to figure out if a dentist is too aggressive or not. Maybe the best way to ask it is if the drilling and removing of decay and tooth structure is the sort of thing that would be pretty much the same from dentist to dentist or would it tend to vary widely with more aggressive dentists being free with going deeper than maybe another dentist would?

Your previous answers about the DyCal, x-rays and composite vs. glass ionomer are helpful.

I thought I had read other posts over time that mentioned something like a sedative filling when drilling close to the nerve. Is there such a thing and if so, when would it be used?

I have an appointment with a different dentist Tuesday - one I saw briefly for a focused evaluation over a year ago when I was trying different dentists before I went with the one I have been seeing. I remember her saying she would use amalgam on a cavity under a crown. I was very surprised at the time. I had thought dentists no longer used amalgam. Could you comment on that - is the industry still using amalgam or would that make her behind the times or odd man out, so to speak?
 
My mother passed away the day that you replied, and I let my dental concerns go the last few weeks.
I'm sorry to hear that, my condolences.

Maybe the best way to ask it is if the drilling and removing of decay and tooth structure is the sort of thing that would be pretty much the same from dentist to dentist or would it tend to vary widely with more aggressive dentists being free with going deeper than maybe another dentist would?
Generally we all try to remove as much decay as we can see. If it's getting close to the pulp chamber then it's a judgement call on how much we can leave... there's no "right" answer.

I thought I had read other posts over time that mentioned something like a sedative filling when drilling close to the nerve. Is there such a thing and if so, when would it be used?
There's stuff called sedative dressings, sometimes you can use them to calm things down if the nerve is a bit jumpy and you want to calm it down a bit... it's not great to use one if you want to use composite to fill the tooth later as they can react with the composite and discolour it. You'd need to either remove it completely which could stir things up again, or else seal it over before using the composite.
I remember her saying she would use amalgam on a cavity under a crown. I was very surprised at the time. I had thought dentists no longer used amalgam. Could you comment on that - is the industry still using amalgam or would that make her behind the times or odd man out, so to speak?
Amalgam still has its uses, it's very strong, easy to use and shows up well on x-rays. It's slowly falling out of use but it's not extinct yet.
 
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