I recently (about 2 weeks ago) got a bridge.  It's on the lower right side of my mouth.  I had one tooth pulled, and the teeth on either side of the extraction were capped.  The caps had to be taken off and the teeth drilled down to accommodate the bridge.  Before the caps were taken off, the teeth were fine.  There was no sensitivity or pain with them.  Now I'm experiencing sensitivity/pain whenever I try to eat anything cold or sweet.  The dentist I should have no more problems with sensitivity like I did with the temporary bridge, but the permanent bridge is creating the same exact problem.  The dentist also said that if I was experiencing problems, I would need a root canal.  The teeth were fine until this!  What should I do now?  Do I need a new dentist?  Is this normal for a bridge?

Dear Janie, many thanks for your question.

Unfortunately, you are not the first patient I have encountered this situation with and it remains one one the most puzzling and somewhat annoying predicaments that clinicians find themselves in. When an otherwise healthy, asymptomatic and vital tooth suddenly displays symptoms of hypersensitivity and associated discomfort following treatment. Naturally the obvious must be excluded first -

1.  Does the bridge have an ideal fit to the tooth abutments, ensuring that all the margins are 100% sealed and meet perfectly?
2.  Was appropriate cement used and used correctly, preventing leaching out under the bridge over time, creating a marginal gap between the inside of the bridge and the tooth surface?
3.  Were all areas of weak and unsupported tooth material and all decay and suspected fractures effectively removed during the prep of the teeth?
4.  What materials were decided on for the final bridge and why? A very small percentage of patients do show varying degrees of hypersensitivity to some dental materials, especially those containing metal alloys.  With the metal-free, porcelain-alone systems, this has greatly been reduced but we still find it occurring, albeit rarely.
5.  Any newly exposed tooth neck areas? The neck of the tooth is a highly sensitive area which is usually protected by the gum but in times of gum recession it becomes exposed. During the prep of some crowns/bridges, retraction cord is often used to move the gum away from the tooth surface so as to highlight and identify the margins of the prep better. This increases the accuracy, fit and aesthetics of the final product but can sometimes result in latent sensitivity due to the temporary displacement of some superficial gum tissue. Usually this takes a few days to weeks to settle down to normal, depending on the technique of placing the cord.

Once all factors such as these have been thoroughly examined and eliminated as a possible cause, focus should start shifting to alternative causes. Only once this has been given a definitive diagnosis, can one consider the possibility of root canal treatment, because root canal is a treatment modality and must never be used as a diagnostic tool to eliminate the causes of undiagnosed oral pain. If it was to be used in that way, patients could end up having most of teeth root canal treated until eventually the offending tooth is correctly identified and treated as it should have been from the very start, thereby sparing the others the fate of root canal treatment. Before root canal treatment is even considered, get a referral to see an endodontist, a root canal specialist, to evaluate the situation in more depth. But I would advise that you give the situation another 2 weeks and monitor the symptoms very closely for improvement or worstening.  The mouth is a dynamic environment so don't expect the symptoms to follow a regulated path - fluctuations may well occur but its the overall picture we are looking at rather than what happens in a single day. If after 1 month - 2 weeks past and the 2 weeks to come - you have the same degree of discomfort, take the matter further, but I can give you the re-assurance that what you are experiencing has very little to do with the nature of dental treatment you have received.  Every clinician has experienced this several times and having very few answers about it ourselves, it poses a huge strain on us professionally. I have never yet encountered a clinician who would intentionally do any treatment that would create pain in any one of their patients - in fact, that is precisely what we do our best to avoid so that patients do not come back with problems later that we have to sort out.

I hope this helps and wish you a speedy resolution of this matter.  You are, of course, always entitled to a second and third opinion if your trust in your clinician is not certain. It remains your mouth and your body and you are in control of it all times - get the advise you need in order to have the confidence that what you are having done, is the right thing and is essential for your oral and general health. Take care

Kind regards
Dr Craig Peck


All Answers

Answers by Expert:

Ask Experts


Dr Craig W Peck ( B.Med.Sc., B.Ch.D., Clin. Botox, Cosmet. Derm.)


I am a General Dental Practitioner, with special interests in Cosmetic Dentistry & facial aesthetics and Periodontology, placing a strong emphasis on the establishment and maintenance of a healthy periodontium (the support structure of the tooth) before cosmetic options are considered. I uphold all principles of prevention above interventional treatment and try as far as possible, to remain conservative in my approach. I believe in detailed, open and honest patient discussion, establishing what the patients expectations are and what the reality is of achieving this and involving the patient at every level of the treatment. I have strong principles on ethical treatment and appropriate patient management. I have chosen to treat and rehabilitate many nervous and phobic patients, who, for whatever reason, find it impossible to take part in the very important task of even a routine check-up. I will accept questions relating to general and cosmetic dentistry (in conjunction with the use of facial cosmetic procedures) and dental fears/phobias. I will be more than willing to answer any academic questions in dentistry, biology, physiology, psychology and health sciences in general. As most dentists will tell you, there is often not only one way of dealing with a dental issue - so very often, there is no precise right and wrong way of approaching the problem. All clinicians vary when it comes to treatments and what works best in their hands is often the treatment that is advised. Be understanding of this and bear in mind that nothing lasts forever! Patients are happy to accept only a one-years warrantee when buying a new car, but seem to expect that dental work is going to last them their lifetime.


I have worked for many years in the UK and RSA as a general dental practitioner - within the NHS, private practice and the government dental health services. I am certificated for the administration of Botox and Dermal Fillers for facial lines and wrinkles as I have attended further courses in minimally invasive facial cosmetic procedures. I started seeing an increasing number of patients who presented with severe to moderate dental fears, even with full-blown phobias, so I started with the slow and patient task of tackling this problem and have successfully rehabilitated many patients. The key is good, effective, concise and understandable communication, shifting control from the dentist to the patient in order to slowly, but confidently, regain their trust back in dentistry, thereby giving them the feeling of achievement and this self-empowerment which drives them to the next level of treatment.

Academy of General Dentistry. American Dental Education Association. IAPAM (International Association for Physicians in Aesthetic Medicine). Professional Speakers, Writers and Managements Consultants in Dentistry. The British Dental Association. UK Aesthetics Group. ARC - Aesthetic Professionals. Botox. Aesthetics & Beauty. American Association for Dental Research. FDI - World Dental Federation. SOURCE1uk. World Dental Hygiene Forum. ProDentalCPD. Public Health Dentistry. Dentist Network. LinkedIn. Who's Who of South Africa.

B.Med.Sc. Degree (Medical Physiology and Medical Virology; Physiology Cum Laude; Stell 1994). B.Ch.D. Degree (Bachelor of Dental Surgery; Clinical Dentistry Cum Laude; Stell 1997). CPR and CPR-Advanced Courses (2000/2001; UK). Clinical Botox (UK, 2001). Cosmetic Dermatology (Botox and Dermal Fillers; RSA 2011).

Awards and Honors
Placed on the Dean's List at University for academic achievement (1994). Highest achievement in the subject Dental Materials. Medal from 3M and the Radiology Association of South Africa for highest achievement in the subject Dental Radiology and Imaging. Medal from The Periodontal Association of South Africa for highest achievement in the subject Periodontology. Highest achievement for Oral Medicine. Highest achievement in Oral Pathology. Received the DASA (Dental Ass. of South Africa) Gold Medal for highest achieving dental student across the 5 1/2 years of the Degree. Passed the subject, Clinical Dentistry with distinction in final year.

©2016 All rights reserved.