Expert: Frederick R. Liewehr DDS, MS, FICD - 11/4/2008

Question
I am in the process of getting new fillings. Never been one to take good care of my teeth. I had a few of those silver fillings that were fine. I recall getting them and not having to deal with the agony I am suffering now.

My issue is and I am hoping you could advise me on this. Is whenever I bite on something hard, crunchy. (E.g. toast) The tooth that got the filling hurts, So I will pull the tooth back and bite again without much discomfort. It was a composite filling I got in. My dentist says this can last a month and I got this filling 2 weeks ago its better some days than others. Can you perhaps explain what is going on? As I have gotten a similar filling on another tooth (both quite deep and quite painful to get) And eating anything with remote firmness hurts. (Resorting to soups for 2 weeks now).

Will the pain go away?
How long will it take to heal?
Should I be overly concerned about it?
What should I do after a month when its not better?

Thank you very much.


Answer
I cannot give you accurate information about your particular tooth or teeth without examining you. However, I can speak in generalities. Many dentists are routinely replacing perfectly good amalgam restorations with composite restorations. There is absolutely no reason to do this, and it is in fact unethical. Amalgam has a proven track record, whereas the composite restorations are very technique-sensitive and even when properly placed have a much shorter life span. From what I have seen, few are properly placed. Obviously my opinion is colored by the fact that I tend to see patients who have had problems following the placement of these fillings, and not the ones who are doing fine. Nonetheless, I see many patients with fillings that clinically and radiographically look conservative, and yet the patients are suffering. We just didn't used to see this with amalgam restorations. It is a known fact, and several hypotheses have been advanced to explain the phenomenon, as well as suggestions to avoid the problem It would appear, however, that either some dentists are not listening, or that the solutions do not work. At any rate, if you have discomfort more than a couple weeks after a restoration was placed, it probably needs endodontic attention. You could try having your dentist take the plastic filling out and replace it with an amalgam, and see how it does. He may refuse, saying he has an "amalgam-free practice", or something similar. I call that a brain-free practice, and I would find another dentist. I have done that with success on a number of occasions. The other solution, of course, is endodontic therapy.