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Dentistry/Dull pain after amalgram filling

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Question
I had some fillings done on wed the 28 of aug.  I was taking a nap the afternoon of dental work and was awoken with a pain. I went back in to my dentist and he adjusted the bite. Said the tooth could also be bruised. They are not sensitive to hot or cold. The pain comes and goes.  It is a light dull pain that is soothed with heat. I also have to wear a night guard because of teeth grinding. Is this pain something that should go away with time or should I have reason for concern?

Answer
Hi Nanc and thanks for your question.

I am sure you can appreciate the difficulty in me giving you a definitive diagnosis and answer without the benefit of being able to examine you or consider the additional diagnostic aids.

I would suggest that you monitor your symptoms over a period of 2 weeks. Should the symptoms worsen or increase in severity during that time, then report this to your clinician for further investigation.  If they remain about the same, then likewise, report this to your clinician as the situation is not improving as it should. There is a possibility it could be a bruised periodontal ligament caused by a bite discrepancy of the new filling, possibly even in combination with your grinding habit. Also make sure that your night guard has adequate fit after placement of the new filling and that the guard is not the cause of the unintentional trauma on this tooth. Your dentist can evaluate that pretty quickly.

It becomes quite open-ended from there, as the possible causes of your discomfort are plentiful and I'm not one for basing recommendations on speculation without proper diagnosis. A few conditions which I have encountered in situations like yours, are:

1. underlying tooth fracture
2. underlying root fracture
3. incomplete removal of all unsupported tooth structure, which reduced the integrity of the filling
4. non-vital or dead tooth, usually caused by deep and chronic decay in the cavity, which requires root canal treatment. Vitality testing can eliminate this possibility.

If this matter persists and a definitive cause cannot be established, then I usually either refer my patients to a prosthodontist for consultation or remove the filling and place a medication in the tooth followed by a good temporary filling for a period of 2 weeks to evaluate the symptoms. if the symptoms improved, then a new permanent filling can be placed - if not, then your clinician must investigate other possibilities - such as other teeth, the severity of your grinding habit and possible TMJ involvement, or even other, less common causes such as the sinus cavities.

I hope this helps and wish you all the best for a speedy and uneventful resolution of this matter.  Pain is a warning sign, so don't just brush it off as insignificant.  Note how your symptoms worsen or improve over time and report these to your dentist - it helps a great deal.

Kind regards
Dr Craig Peck

Dentistry

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

Expertise

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.

Experience

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.

Organizations
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.

Education/Credentials
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.

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