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QUESTION: Dear Dr. Amin:

    I've received conflicting info from different dentists re: the following 2 questions and hope you can advise.

(1# Post Bonding Trigeminal Nerve Problem
    I had a surface bonding work done in the front near the root of my tooth #20 for about 1.5 years ago.  For the 1st two weeks, it gave lots of pain when I chew on that tooth.  Then, I've been experiencing heavy pressure feeling, slightly lack of sensation/numbness along the trigeminal nerve  distribution of my face and jaw.  It comes and goes, sometimes worse and sometimes slight.  Can the bonding be removed and left with its original condition? Or will the tooth and its nerve tend to  experience more trauma or damage from the removal process?  If removal is recommended, do you recommend leave it alone after the removal or try a different bonding material?  It's a hard decision for me.

#Originally, one dentist did not recommended bonding because he claimed it will keep falling off.  The dentist who did the bonding claimed that she is highly experienced at securing it tightly so it won't fall off.  Maybe it's too tight?#

#2) When to refill when a piece of filling falls off?
    Some portion of my fillings fell off the top of my 2 teeth, which does not seem to affect my chewing function. I went to my dentist and was told to just leave it there because the edge and contact to the adjacent tooth are not affected. And then, more fell off from the same tooth.  At what point should I insist the tooth to be refilled in order not to further damage it?

    Your opinion is appreciated.

ANSWER: Hi Lia,
Sorry about your recent dental issues.

#1:  It's rare for the dental nerve to be a trigger for trigeminal neuralgia.  However, if in fact this is the case, then removing the bonding will be a form of trauma to the dental nerve.  
I suggest you see an endodontist (root canal/dental nerve specialist) to evaluate the tooth.  Perhaps the nerve is dying inside the tooth and causing the sensation you are describing; though it wouldn't cause numbness.  My other advice is to manage the sensation with a neurologist accordingly.  It's not possible for a filling to be "too tight", if it's staying in place, that's great.

#2:  If you are continuing to catch food in the portion of the chipped filling, then you should replace with another filling or crown.  Catching food and having a hard time cleaning that area could cause decay and more problems later.

Hope this helps,
KG Amin, DMD
www.AustinCenterEndo.com



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

QUESTION: Dear Dr. Amin:

    Thank you.  Do I interpret correctly that removing the root bonding on tooth #20 can further damage the nerve rather than alleviating the pressure against the nerve?  (It was quite painful chewing on that tooth for about 2 weeks before the recurring trigeminal nerve problems, along jawline, under eyes & cheek area, began.  After that, there has been not much pain but more pressure, lack of sensation feeling.)

    Will it be possible that the pain associated with the bonding caused me to chew differently which triggered TMJ that has been irritating or damaging the trigeminal nerve?  I am not sure whether I need to see a TMJ specialist aside from an endodontist. I've seen a neurologist last year who told me the feeling will go away  But it has recurred repeatedly.

Answer
Hi Lia,
Sorry for the delay:  I just saw your follow-up questions.

Yes, repeated procedures on a tooth can irritate/damage the nerve in tooth #20.  More than likely, you had some level or TMJ or Trigeminal Nerve issues before the filling.  I would see a TMJ specialist as well also perhaps another neurologist or follow-up with the same neurologist as the pain as not gone away.

Hope this helps,
KG Amin, DMD

Austin Center for Endodontics
Austin Center for Endodontics

Dentistry

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Ketan Amin, DMD

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Graduating from Harvard School of Dental Medicine, I received a broad understanding of both medicine and dentistry. I continued my training at New York University, as a dental specialist in endodontics, which concerns root canal therapy, related surgeries, as well as diagnosing and managing various forms of pain occurring in the head and neck

Experience

Dentistry; Specialist in Endodontics (Root Canal Therapy).

Organizations
American Association of Endodontics American Dental Association American Academy of OroFacial Pain

Education/Credentials
Harvard School of Dental Medicine-Doctorate in Dental Medicine (DMD) New York University College of Dentistry-Certificate, Endodontics

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