Tooth sensitive to heat

[Anne2021]

I am trying to prepare for the next step in my dental care. This is the year that I am trying to push through and get everything that needs doing, done. I have decay on teeth 13 and 14. I have already lost 12 and 15. I have a 23-year-old porcelain-to-metal crown on 14. I have a filling in 13. Both teeth had some evidence of beginning decay in 2017 so the cavities have been there for a while. I am now having temperature sensitivity in that area. I am certain that there is sensitivity on 13, but I can't be sure about 14 because I'm not sure if it's all coming from 13. I need a large filling, possibly a crown on 13. So far, the dentists I have seen want to try to fill the decay on 14 without removing the crown and see what happens when they get started. (I say dentists because mine retired and I have been trying others to see who I can work with best). My best guess is that 14 is somewhat sensitive to cold but not heat. I am certain that 13 is sensitive to cold and heat. Neither produces severe pain or lasts, but it is noticeable. (I had a tooth that was very painful to cold for over six years before it was removed and it's not like that). I am currently waiting for the appointment day to come - four more weeks.

I had thought that I had heard that heat sensitivity is a worse sign than cold sensitivity and more likely indicates that the nerve is in trouble. Due to my issues - primarily the phobia - I know I could not ever force myself to get a root canal. The obsessive fear of that is too great for me. I have already lost eight teeth in addition to my wisdom teeth and if it needs a root canal, I choose extraction. How much hope is there for a tooth with heat sensitivity to be restored with just a filling? Is it likely that I am too late?

 

[Dr. Daniel]

Hi,

It depends on the reason for the sensitivity to heat. May I ask: why are you so reluctant to have a root canal treatment?

 

[Anne2021]

@Dr. Daniel Thank you for your reply. My reluctance to have root canal treatment is due to my fear of any and all dental work. i have complex PTSD from a history of abuse, and when I was in my 20s, I began to be afraid of the dentist, likely due to the vulnerability. I also have a mitochondrial enzyme deficiency that is very rare and often things just go wrong for me where health-related things are concerned. I don't like to be touched at all by any health care professionals. As a child before the phobia began and before the mitochondrial deficiency symptoms started, I went to the dentist like normal. Though my parents did not get us preventative treatment or cleanings (maybe one or two as a child), I had fillings and had my wisdom teeth extracted in my late teens. I never had a root canal before (or after) the fear began. Then my sister shared stories of her root canal failures, including one tooth that had two root canals and two apicoectomies before they finally extracted it. I knew I could never tolerate that. Perhaps it is because I had fillings and extractions before. Maybe it's her horror stories. I just know that it is not something I will be ever able to do. My parents also always opted for extraction over root canals. I also fear the procedure more with fillings than with extractions. It's just too ingrained in me now to change. I struggle with a lot in life due to the complex PTSD and this is one of many things.

Could you elaborate on the sensitivity to heat and which reasons would mean root canal or extraction versus which reasons might offer hope that a filling could still restore the tooth?

 

[Dr. Daniel]

generally speaking, a tooth can be sensitive to extreme stimulus, and that is a sign the nerve is irritated. The consensus is that sensitivity to heat has a higher threshold than sensitivity to cold, meaning in the case of heat- the nerve is more excited compared to cold.
But again, this is all theoretical.

 

[Anne2021]

Thank you, Dr. Daniel.