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Sensitive Teeth NEED Amalgam?

D

Deleted member 29654

Former Member
Right now, I am at a loss. I don’t know what is happening to me. I fear what is going to happen next. I would like some input or clarification since I am unsure if what my dentist is saying is true. Do sensitive teeth NEED amalgams? What?!

I apologize for the length of this post. Thank you in advance for any response to this post.

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Twenty (20) years ago, my family and I went to a reputable (and now retired) dentist in Mexico to have work done. He gave me two porcelain or resin fillings (which I still have and are good) for an upper incisor and canine. He also gave me two amalgams on the bottom left, one on the top left and one on the bottom right. This was all done in one sitting. I never needed to go back for adjustments, never had any problems with them, never had a leak or crack in them, and did not experience any pain. I have had very mild cold sensitivity since I was a teenager, of which the fillings offered no additional discomfort.

I developed another cavity in my bottom right molar, which never gave me any pain. Finally, this year, I decided to go to a dentist to have my cavity looked at and to examine the condition of my amalgams. On the corners of the amalgams (on the enamel itself), it was obvious there were caries forming. I went to a reputable dentist I found online, got an exam and paid out of pocket. I was told that the amalgams were failing and would need to be replaced soon. There was no leaking at that time, but he wanted to err on the side of caution.

He showed me an x-ray of my teeth and all my amalgams were shallow and nowhere near the pulp or roots. The cavity itself was close to the root, but not close enough to require a root canal or pulp capping. I got a quote and, since I had enough money to do the procedure, I made an appointment. At my request, we all five (5) fillings at once, although he was uncomfortable with it (as I was under the assumption it would be no different from Mexico, drooling and all). I paid upfront and we started.

The amalgam was drilled out and removed (the “normal” way, not holistically) and replaced with composite resin. A filling for the cavity was also placed. One thing I noticed after it was done was that there was no “cusp building” technique used. They were smooth, flat fillings like my amalgams had been. The other thing that I noticed was that dark gray areas were present in the resin replacements; some more noticeable than others.

For the first two days, nothing seemed to be amiss. I was gentle with my teeth and didn’t chew anything too difficult. Then, on the third day onwards, I have undergone different symptoms at different times with different triggers or no triggers at all on all my five (5) fillings (not just one, but sometimes one tooth or one side might be a little worse than the other).

This has persisted for six (6) weeks so far. I have had pressure sensitivity (solids, clenching), air sensitivity (pressure and temperature) and food/drink temperature sensitivity (hot, cold, sometimes even tepid). I have had no sugar sensitivity and the only symptom that had been consistent on all five fillings has been pain with chewing. In addition, during bite adjustments, some of my teeth might hurt a little—especially on my upper left molar.

I have had three (3) bite adjustments and each sitting was about twenty (20) minutes. I had additional x-rays done during the second adjustment, which he said showed that I did not have pulpitis or inflammation. After my third adjustment, the dentist told me the if nothing improved, the next step would be to replace my fillings.

He told me that my teeth are “sensitive”, and it was possible that they simply could not tolerate composite. He explained it was possible I could only tolerate amalgam, for their “sensitivity dulling properties”. He did, however, admit that there may have been possibility that somehow the procedure “got messed up” since we were doing both sides at the same time. I explained that I wanted to try and redo them in composite, since I am uncomfortable with having amalgam again. He told me that if it came to that, he would redo them one or two at a time.

After the wait period and reported back that nothing changed. He asked me which tooth was bothering me the most and although they are all pretty much the same, I said the upper left molar. He was initially intended to go straight to amalgam, but I asked again to try composite. My appointment is the end of this week. To be honest, he seemed to be bothered by the whole affair—the adjustments and the idea of redoing the fillings.

My concerns are many. I initially thought my problem was a high filling. After the first and second adjustment, that is what the dentist thought too, along with interference from my “pointy teeth and deep bite”. Then, during the third adjustment, he said my teeth are just “sensitive” to dental work. I know my mother and grandmother both had amalgams replaced with composite recently and they both said it took a month to go back to normal (without any adjustments), but that was just chewing sensitivity, not anything else, and I have no idea how deep or shallow those filling replacements were.

I’ve read things about temporary sedative fillings, new and more efficient bonding agents, and better (and more expensive) composite compounds with higher fluoride concentrations for sensitive teeth and remineralization properties. I’ve read about new techniques (and specific materials) developed for sensitive teeth, with pain after a filling being either minimal or nonexistent. I’ve read about people who have had their amalgam replacement fillings done with resin and redone with resin, without any mention of going straight back to amalgam by their dentist.

I am unsure if the problem is with me or my dentist. I just don’t know. I am at a loss and I just wish to go back to being normal again.

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Age: Mid 30s
Sex: Female
Conditions: Overbite, Mild Cold Sensitivity, High Pointed Cusps, Partially Impacted Wisdom Teeth, Coffee/Tea Stained Teeth, High Novocain Tolerance, Sensitive Upper Teeth (to dental work only)
Restorations: Four bottom posterior molars, One top posterior molar, one top incisor, one top canine (Current)
Notes: I cycle between two types of toothpastes—Stannous Fluoride for Sensitivity and Sodium Fluoride/Potassium Nitrate for Sensitivity, plus in the morning I do a saltwater rinse after eating and a half-hour to an hour before brushing my teeth
 
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Gordon

Gordon

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Composite fillings are very technique sensitive, the bonding has to be virtually perfect or else you get problems with sensitivity etc. All of them, no matter which generation of bonding agent etc are used.

Amalgam fillings are pretty much idiot proof, no matter how you sling them into a cavity they'll generally work fine.
 
D

Deleted member 29654

Former Member
Composite fillings are very technique sensitive, the bonding has to be virtually perfect or else you get problems with sensitivity etc. All of them, no matter which generation of bonding agent etc are used.

Amalgam fillings are pretty much idiot proof, no matter how you sling them into a cavity they'll generally work fine.

Thank you for responding. I really appreciate it.

I have read that that is easy to botch composite fillings (especially if the tooth isn't perfectly dry and he used cotton spacers), but did not know that amalgam is, as you say, "idiot proof". I had only read that the materials used were cheaper and that the amount of time spent on the procedure was significantly less.

As I said, I read about specific techniques recently developed that are used for reducing or eliminating the chance for sensitivity (with exception to bite adjustments, of course). What I am confused about is how ALL of the fillings are symptomatic. Did he botch ALL of them? Is that possible? I am also concerned about how the dentist wanted to immediately go right back to amalgams and that I had to convince him to try resin again.

This is from a dentist who has been in the practice for almost thirty years and claims to go to workshops every year for continuing education. Yet, there were no "cusp building" techniques applied and I have dark gray spots in my resin replacements. Is that normal?

Another thing is that I remember when I got my amalgams done originally, the dentist had a small square with something on it. He rubbed the "pit" he drilled out of each tooth with it. I asked him what it was and he told me it was "medicine" (maybe topical fluoride?). When I asked my new dentist about it, he told me that wasn't medicine--it was a bonding agent. Is that true?
 
Gordon

Gordon

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It was most likely cavity varnish. An old fashioned "lining" material that you used to seal the dentine before putting the amalgam in. It smelled fantastic :)
Yes, amalgam is cheaper and the amount of time spent to put it in is less than composite, but it's much more forgiving of sloppy technique.
 
D

Deleted member 29654

Former Member
It was most likely cavity varnish. An old fashioned "lining" material that you used to seal the dentine before putting the amalgam in. It smelled fantastic :)
Yes, amalgam is cheaper and the amount of time spent to put it in is less than composite, but it's much more forgiving of sloppy technique.

Ah, I see. I can't really say I remember a smell, but it has been twenty years...

So, what are the chances of botching five composite fillings done all at once, though? I'd understand one or two, but all five?
 
Gordon

Gordon

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Rather depends on how they were done, doesn't it?
 
D

Deleted member 29654

Former Member
Rather depends on how they were done, doesn't it?

Yes. I just had one of them redone on Saturday. The five were done in an and hour and a half and this one took 45 minutes.

Anyway, so last week I suddenly developed intense temperature sensitivity on my left and mild sensitivity on my right, on top of my inability to chew. When going in on Saturday, I asked to do a bottom filling instead of the top one, since it had become slightly worse of the three.

First off, he was completely baffled by my symptoms these past six weeks or so. That some symptoms came, subsided, returned, affected all teeth or one side, etc. The inconsistently was something he told me he never had seen before in his thirty years of doing dental work. I have been keeping a journal of my symptoms, so there isn't some miscommunication going on.

Anyway, he decided to do thinner layers and make the new filling as dense as possible in order to simulate an amalgam. He drilled out a tiny bit more to remove the staining from the amalgam and proceeded to layer on the material, then compact it forcefully with his thumb (which he did several times). By the time the novacaine wore off, my jaw was hurting and it was a bit sore up until today.

I asked when I should notice any difference and he was honestly unsure. He said maybe days, maybe up to two weeks, but he wasn't sure of anything. So far (Monday) there hasn't been a difference.
 
Gordon

Gordon

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The biggest reason for sensitivity after composite fillings is bond failure at the earliest stage before the filling goes in.
Doing the filling in layers is a good idea, to make sure that the composite is being fully polymerised by the curing light is also a good thing, because sometimes the composite isn't fully set and can "pump" into the nerve during chewing.
 
D

Deleted member 29654

Former Member
The biggest reason for sensitivity after composite fillings is bond failure at the earliest stage before the filling goes in.
Doing the filling in layers is a good idea, to make sure that the composite is being fully polymerised by the curing light is also a good thing, because sometimes the composite isn't fully set and can "pump" into the nerve during chewing.

The complications of tooth-colored fillings are new to me. It's also a bit difficult to discern whether or not improvement has occurred, considering I have two others on the left side to deal with. I know at least the pressure sensitivity is the same, but I guess I shouldn't expect miracles so soon.

If this new application does not work, does that means I am doomed to go back to amalgam? I also would hate to go back only to find out that it doesn't resolve my problems. I'd ask my dentist, but his lack of confidence as of late makes me leery.

By the way, thank you for your input on this.
 
Gordon

Gordon

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They are great but they are very demanding in terms of placing them.
If it's just pressure sensitivity not hot and cold, then it sounds like the bite may need some checking, bond failure usually shows up as thermal sensitivity rather than pressure...
 
D

Deleted member 29654

Former Member
It's both, actually.

I had cold sensitivity on both sides develop a few weeks after the initial procedure, but it wasn't too bad. Then, maybe two weeks ago, I suddenly developed painful sensitivity on my left and milder sensitivity on my right to anything other than lukewarm. Chewing sensitivity remains as always on both sides.

Note that unless I am testing for sensitivity every couple of days, I am not chewing food and haven't done so in about a month. The dentist knows this.

Today, I took a little shaved ice and put it on the tooth and let it melt, then I tried cold water. I waited for the tooth to warm up on its own before trying hot water. It seems the redone filling has improved on the temperature sensitivity (not fully), but no change on the chewing aspect. The dentist left for the day, so I'll find out what he thinks tomorrow.

I had asked him on Saturday about how long it will take for any changes. He was unsure; a few days or up to two weeks he said. Does that sound right? When the heck am I going to be back to normal? I'm almost to the point where I just want these damn things pulled out.
 
Gordon

Gordon

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If it's a bonding failure, then correcting it should almost instantly solve the sensitivity.
 
D

Deleted member 29654

Former Member
If it's a bonding failure, then correcting it should almost instantly solve the sensitivity.

Then it is obviously NOT that. It still has some temperature sensitivity, but so far there has been no change at all regarding chewing or pressure sensitivity.

[EDIT] I just called today and am going in tomorrow to have another tooth redone (in composite). He may also do another x-ray, just to be sure of things. Ultimately, he said I have a choice: wait 2-3 months to see if there is any improvement, or go back to amalgams. He has no problem in doing them again in composite, one at a time, but feels that if I don't want to wait months for improvement, I'd have to go back to amalgam because "my teeth are sensitive".

This is so STRESSFUL.
 
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D

Deleted member 29654

Former Member
[UPDATE]
On Saturday I had another filling redone in composite. The two back molars on my bottom left are no longer experiencing intense temperature sensitivity; instead, it is slight. My upper left molar and two right molars remain as they were. The dentist did not change the bite of the first redone filling and remains sensitive to pressure and chewing. There has been no change in chewing sensitivity to the newly redone far left molar thus far.

He wants an update tomorrow, but he seems kind of wishy-washy. On one hand, he said I may need to wait 2-3 months for any improvement on the composite. On the other, he is pretty determined to go the amalgam route. He said he is fine doing the other three again in composite, but that's only if there is improvement on the other ones.

This dentist sure doesn't instill a lot of confidence in me, especially since he said I will likely get to go through this all over again in 6-7 years if I keep the composites. OH BOY! :shame:
 
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