Expert: Mark Bornfeld DDS - 3/3/2009

Question
Hello,

I recently had some new fillings drilled and filled with amalgam filling almost a month ago. Ever since I've had these fillings, specifically in the teeth with fillings I am extremely cold sensitive. This goes on to the point where I can no longer rinse my mouth with mildly cool water, drink anything cold, or even breathe in cold air (Which is devastating as I live in Michigan, it's cold all the time.)It is also extremely heat sensitive, anything hot gives the same pain. If it's not cold.heat sensitive, it randomly throbs in pain. Also, the point in the back of my jaw where the Dentist stuck a needle in (twice) now randomly aches and sometimes will not let me open my mouth little more than a quarter inch wide. I don't know what the problem is, I've had amalgam fillings before and this has never happened. How should I go about getting this sorted, I can't even chew on that side sometimes without shooting pain. Are there any other alternative fillings that give less sensitivity? They were apparently very small fillings and I'm loath to get root canals in multiple teeth. Any advice would be appreciated. Thank you.

Answer
Dear Lindsey,

I would advise against any active intervention at this point unless it is clearly necessary. Any additional instrumentation (short of root canal therapy) on the teeth will only serve to make them more sensitive. Also, amalgam is relatively unlikely to provoke sensitivity when compared with other commonly used filling materials, such as composite resin, so a change in the filling material used would be counter-productive.

The limitation of jaw movement is due to injury of the muscles from the anesthetic injection, and will eventually resolve on its own. The tooth sensitivity is more potentially problematic, but unless there is a true pulpitis in one or more of those filled teeth, it will eventually pass as well.

If you have noticed any lessening in the sensitivity of the teeth over time, that should be interpreted as a favorable sign, and you should not do anything that might alter this improving trend. On the other hand, if the sensitivity is getting worse, then you probably have a root canal treatment in your future.

What is more uncertain is what you should do if the sensitivity persists at a level and for a length of time that you are unwilling to endure, even if it doesn't get worse. In cases like these, I will sometimes remove the fillings and place a sedative dressing for a trial period to see if symptoms resolve. If they do, I will eventually leave part of the sedative dressing in the tooth permanently, and re-insert the amalgam filling over it. If symptoms don't resolve, a root canal treatment will usually do the trick.

Mind you, this is how I manage these problems in my practice; your dentist may have his own philosophical treatment algorithm. I would recommend that you consult with him so that you can get his input.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY