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Dentistry/Pain When Biting Down On New Filling - Dr. Says Not To Be So Sensitive

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Question
Hi Dr. Peck,

Over a month and a half ago I had an upper left molar filled with a white filling - I'm not sure exactly what it is but it did have to be light cured. However when I ate on that side a day later, I suddenly got a sharp shooting pain, a pain I've never felt on my teeth before. Later that night, I found using floss between that molar and the one before it gave me a sharp shooting pain, like a nerve is getting pulled. I called the dentist and she replied that it could be due to the filling being too high, and to give it time to settle. I went on vacation for a month, and during that time I always felt a dull pain. After a week or so, using floss produced a sharp pain on both sides of the tooth. Eating hard objects would produce a pain too.

My sensitivity to hot and cold is fine, simply biting down or grinding does not produce pain, it's just chewing food at a particular point that produces pain and a dull pain even after the stimuli is removed. I am 20 with overall good oral hygiene. This is a tooth that was previously filled but after I moved the new dentist noticed a gap and said it had to be redone so I listened to her.

I thus switched to eating entirely on the other side, and as soon as I returned home I went to the dentist again. She took an x-ray and picture and said there was absolutely nothing wrong with the filling. Instead, she told me to be less sensitive. She gave me the attitude of someone who thought I was making a big deal out of nothing.

It's been almost 2 months and when I tried chewing on a soft orange the sharp pain still existed when I chewed on it, and leaving a dull pain after the food was removed.
I'm worried because I'm at school, and I won't be home for 3 months. Should I be worried something bad is happening? I'm petrified that I will need a root canal.

Thank you!
Avery

Answer
Hi Avery and thanks for your question.

Firstly, let me express my dismay with your current dilemma. Oral pain is a very real symptom and should always be investigated fully by every clinician. The fact that the type of pain you are having now is new, tells me that the origin might well as a result of the recent dental treatment - although I cannot give a definitive diagnosis without examining you personally or viewing the X-rays.

I have also experienced this problem clinically before with some patients and the cause is greatly unknown. Sometimes, it could be as result of a fracture in the composite material, leakage between the filling and tooth interface which allows moisture to enter and cause pressure fluctuations under function, a fracture in the floor of the cavity where the filling was placed, loss of proper contact between the filling and the adjacent teeth which allows for food impaction or accumulation between which aggravates the gum between the teeth, or a high filling which affects your bite during function and places an abnormally high pressure on the filling and/or the normal tooth. Those are the most common causes, but I cannot narrow it down any further - with regret.

What I would suggest, is that either get a second opinion on the matter and get all the teeth in that fully evaluated because there is of course, a chance that these symptoms could be purely co-incidental and involve another tooth near by, or could even be as a result of another undiagnosed pathology. It might be a good idea, to have the filling removed completely and replaced with a temporary filling which has a softer consistency and tolerates your bite better, for a period of 2-4 weeks during which time you should evaluate the changes in the pain and discomfort. Should your symptoms improve during this time, then your dentist could discuss what options are available to you, or if not, then possibly refer you to an endodontist for further examination and diagnosis of the problem. Most clinicians have a guarantee period for their work, so if the filling needs to be replaced, it might be covered under the principle of a redo procedure, but discuss the costs involved fully.

I hope this helps and wish you all the very best in resolving this issue speedily, take care.

Kind regards
Dr Craig Peck

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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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