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Dentistry/Possible Root Canal Needed

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QUESTION: 3 weeks ago I received two fillings. For the first few days there was very little pain or soreness. They then began to hurt when I chew. I've since gone back for two bite adjustments. After the last bite adjustment last Monday, I switched to soft foods and my teeth seem better. They still occasionally hurt, and I take Advil maybe once or twice a day, but they seem to be improving. Last week I also noticed that I began to have lingering pain after eating cold fruit. Only cold fruit, nothing else cold really causes anything. At first it would last quite a while and I would take Advil, and it would subside. Two days ago the cold didn't long et when I tested it and then yesterday it longer just a little 10 min or so. Everything I read days lingering cold pain means I need a root canal. My dentist has informed me that he thinks I have very sensitive nerves and to give it more time. My question - does lingering cold pain always mean I need a root canal or could my tooth still be settling after my filling.  It does seem to be getting better, but could that mean the nerve is just slowly dying, and really it's getting worse.  

I also went to another dentist last week for a 2nd opinion and had them take a xray of just that tooth.  He said he saw no signs of infection, and even mentioned the filling was far enough away from the nerve that it shouldn't cause problems.

I again spoke with my dentist last night, and he continues to feel that I should give it more time.  When I take Advil it generally lasts about 12-14 hours, so I took it yesterday morning and was fine throughout the day and evening, but I woke up last night and my teeth hurt.  It wasn't intense and I was also worried, so I took 2 advil and now once again I'm completely pain free.  

I've also always had tmj, and there is a spot that feels sore when I open my mouth, but I wasn't sure if this could be some form of infection spreading or just a sore jaw.  The sore spot was there when I had an xray and the dentist felt my neck, but didn't feel anything.

Anything you can provide would be great.

ANSWER: Hi Tom,

I'm sorry to hear you have all this going on. Let me try to help. Let's start with the easy one. When you feel cold in a tooth, that means the nerve is still alive or you would not feel temperature sensations. Therefore, you don't have an infection started so that would not explain your soreness in the area of your TMJ and why there is no evidence of an abscess on your x-rays.

When a filling is done and the bite feels high, like yours did right after your treatment, the constant "pounding" of your teeth together will inflame the nerve of the tooth and can cause it to become more temperature sensitive, especially to cold. That's what we often see this several days after a filling because it takes that long to really get the nerve irritated. Once the bite is correct, it can take some time for things to return to normal. The problem is trying to decide if things are really getting better or the nerve is actually dying so it becomes less cold sensitive. There is really no way to make that call except to give it time. If all returns to normal and you have no symptoms, then you will have a pretty good idea that healing has occurred. If, on the other hand, the cold sensations go away but you have hot sensitivity, soreness to bite, pain or swelling, then it may mean the nerve has died and you'll need a root canal.

At this point, I would agree with your dentist. Just give it a little more time. However, I would make sure your bite is OK. Hold your teeth together firmly and slide from side to side. Then "clack" your teeth together. If either of these things cause you any soreness, you may need more bite adjusting and you should call your dentist.

I hope this helps explain things. Write back if you need more info.

Gary Backlund DMD, MSD

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

QUESTION: Thank you for getting back so quickly.  I'm take your word for it and give it a little longer.  You just read the internet about the horror stories of infections getting out of hand, and it gets the brain going.  My final question is that if a lack of cold sensitivity means the nerve is dead, how will I know if it's getting better or dying, and then the day that it doesn't hurt, how will I know if I'm all better or if I now have a dead tooth.

Thanks again for your help, this tooth pain that isn't that intense is just too much of a gray area.

Answer
Hi again Tom,

There is really  no way for you to know by yourself for sure whether things have healed or the tooth has died. However, you can test your tooth yourself and that will give you some idea. A healthy tooth should feel some cold, but it should not be painful. You can take a sliver of ice and touch the tooth down by the gum. Make sure it doesn't touch the gum or adjacent teeth. You can practice on other teeth to get the idea of what a healthy tooth should respond like. Other than that, I would just wait for symptoms to develop such as hot sensitivity, soreness to pressure when chewing, swelling, pain, and things like that. Then beat feet into your dentist should you feel those things. Hope that gives you some idea of what to do and look for.

Gary Backlund DMD, MSD

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Gary Backlund, DMD, MSD

Expertise

I am an Endodontist ( root canal specialist ) and can answer questions about root canals and their treatment. I cannot diagnose or treat online, but can answer general questions. I have been a specialist for 25 years and am Past President of the Washington State Association of Endodontists.

Experience

25 years practicing as a specialist

Organizations
American Association of Endodonists, Past President Washington State Association of Endodontists.

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