Expert: Benjamin Schwartz, DDS FAGD - 10/7/2008

Question
QUESTION: My dentist replaced my amalgam fillings for teeth #19, 20 with tooth colored filling last March.  The fillings were fairly big.  (Another dentist earlier thought that I would need a crown.)  The new fillings look great, but I immediately noticed that they were pressure sensitive when I bite down.  I have gone back to the dentist 3 times now, and with each visit, the pressure sensitivity improved.  I would say that I am back to 90 plus percent of "normal".  I still have residual sensitivity, when eating crunchy foods like chips or very firm food like apples.  (Definitely no raw almonds for now.)

What would you attribute the  "hard to fix sensitivity" to?  Does my dentist not know how to adjust my bite?  Does it really take many tries to adjust the bite after a composite filling?  or do you think there might be another reason altogether?

ANSWER: Hi Rosie,

When you clench your teeth together, with no food in your mouth, do the teeth hurt?

While restorations may need to be adjusted once or twice, they usually don't need 3 times. Nor, should you still be having pain when eating hard foods on that side.

I would have your dentist check to make sure there are no fractures in the tooth. If there is a fracture, even a small one, that can be the cause of your problems. Everytime you bite on it with a hard substance, you are propagating the crack, causing sensitivity and pain to occur.

Does one part of the tooth hurt more than another when biting down with food? If so, this may be a cracked tooth, and not just a bite issue. I would recommend having this examined by your doctor asap for further evaluation.

Good luck!

---------- FOLLOW-UP ----------

QUESTION: Wow!  Thanks for the incredibly prompt reply!

No, there is no pain when I clench without food.

How does a dentist check for fractures?  Does an x-ray reveal that?  Is a fracture consistent with the fact that I felt improvement with each occlusal adjustment after the filling?

I cannot tell that there is one part that hurts more than another part when I chew crunchy/firm foods.  It just feels "sore" upon biting.  No heat/cold sensitivity either.

Thanks again.  

Answer
Hi,

An xray wouldn't show a fracture. Your dentist can check each of the cusps on your tooth to determine if one is more pressure sensitive than the rest.

It's a tough situation you're in. It doesn't look like there is one definitive factor here. Maybe your dentist should completely take the tooth out of occlusion, so you don't hit on it at all. Then, after a week or two like that, you can see how the tooth is feeling.

Please let me know how it goes.