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Dentistry/Pain After Broken Tooth Filled

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Question
Hi Dr. Finnk,

There's a bit of history to this question: I had pain in a lower molar when chewing on certain foods for about 2 years. The pain became progressively worse, and I saw 2 dentists in attempt to find the cause. They guessed it could be a small crack in the tooth, but were unable to replicate the pain by doing various tests. The pain started to get quite a bit worse about 2 months ago. I saw an endodontist who was able to replicate the pain and determine which tooth had the crack (tooth #30). He recommended seeing my dentist and having either a full crown on onlay put on the tooth to hopefully fix the pain issue without need for a root canal. I made an appointment with my dentist, but just a few days before my appointment, my tooth broke while I was eating.  Pretty amazing timing considering I'd had the crack for about 2 years! It wasn't a huge break, basically a part of a cusp fractured off. I saw the dentist the next day, and she said she could try to restore the broken area with a filling. We made an appointment for the next week.

While the tooth was broken, it was less sensitive to chew on, but if I touched inside the broken area, even with my tongue in the right spot, there was a very sensitive pain. The dentist had taken an x-ray and saw no decay or inflammation, but the fractured off area looked like it was pretty close to the pulp.

After having the (composite) filling placed last week, I am very discouraged to find that I again have regular pain when chewing food with that tooth, enough so to cause me to only chew on the other side of my mouth. It's not as severe of a sharp pain as before the cracked piece broke off, but it actually happens more easily (less force needs to be applied to cause the pain). The dentist said that the tooth would likely be sensitive for a month or more, but this seems like more than post-operative sensitivity. It's not actually sensitive to cold or hot at all, only the pressure. Even just pressing lightly on the filling area with my finger causes pain.

I guess my question is: what seems the most likely cause of this continued (but different) pain? Is there another hairline crack extending through part of the tooth (maybe a continuation of the crack that caused the cusp fracture, or a separate crack)? Is the composite filling pressing on a sensitive, thin layer of dentin above the nerve and transmitting pain when pressure is applied? Maybe the filling wasn't well placed?

It's seeming like a full crown is probably going to be needed to get this tooth to stop hurting during chewing. I was actually glad when the cusp broke off because I figured that was a good way for the crack to reveal itself, and that maybe a filling would be enough, but it seems like there is still a problem.

Thank you in advance for any input, similar experiences, or advice!

Answer
Dear Patrick,

The fact that your tooth hurt until it broke tells me that there was a hairline crack in the tooth.  There may be several reasons that your tooth hurts less now with the composite filling, even when you touch it with your finger.  It may be that the composite did not bond well to the tooth, and this now is acting like a hairline crack.  Or there is another hairline crack in the tooth [hairline cracks often can't be seen without a microscope].  Or the composite is hitting too heavily when you bite [hyperocclusion].

Hyperocclusion is easy to fix.  Just tell your dentist that this tooth continues to hurt when you put pressure on it.  Ask if he will adjust it so that it does not hit at all when you bite [hypocclusion].  After this adjustment, wait one week to see if the pain doesn't go away. If it goes away, you're done.   If it persists, you will need a crown.  

Good luck.

Dentistry

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Howard Finnk, D.D.S., P.A., CEO

Expertise

I am a Family, Implant and Cosmetic dentist. I will answer questions on any aspect of dentistry and matters relating to the smile, gums, jaws and lower face. Member American Dental Association, Florida Dental Association, Broward County Dental Association, and Atlantic Coast District Dental Association. I have served as District Council Member of Alpha Omega, as well as serving for one term as its President. I am also a member of The Vedder Honors Society, Broward Dental Research Clinic, and Mount Sinai Hospital Guild. I have served as a Volunteer for Project Dental Health and The Tri-County Dental Health Council.

Experience

Having attained over 30 years of clinical experience in private practice in Michigan, in 2001 I was re-certified by taking and passing the Florida State Dental Board Examination. After moving to Florida, I spent nearly 10 years re-honing my skills while working as an Associate Dentist for several large dental groups. In September, 2004, I was appointed Adjunct Clinical Professor at Nova University's College of Dental Medicine. I am certified in placement of Mini Dental Implants, and I am Director of The Florida Implant Center (floridaimplantcenter.com). On March 1, 2010, at the age of 62, I began all over again by buying a dental practice near my home in the Fort Lauderdale area. As sole owner and Chief Dental Officer of the new Nob Hill Dental Center (nobhilldentalcenter.com), I can now carefully provide dental care to patients who care, all within a caring, joyful environment. Over my career lifetime, I have provided thousands of diagnoses, fillings, crowns, bridges, root canals, periodontal treatments, TMJ therapies, partials, dentures and extractions, and dozens of implants for my patients. The only aspect of dentistry with which I have very little experience is orthodontics.

Organizations
American Dental Association, Florida Dental Association, Broward County Dental Association, Atlantic Coast District Dental Society, Vedder Honors Society, Broward Dental Research Clinic, Alpha Omega Alumni Association, and American Association of Dental Implantologists. Formerly, American Academy of General Dentistry, Michigan Dental Association, Macomb Dental Society, Detroit District Dental Society, Tri-County Dental Health Council (a charitable dental care organization)

Publications
"How To Save Money At The Dentist" Going to press soon.

Education/Credentials
Bachelor of Arts and Sciences in Psychology from Wayne State University Doctor of Dental Surgery from University of Detroit College of Dentistry Adjunct Clinical Professor, Special Needs Department, Nova Southeastern University College of Dental Medicine, Fort Lauderdale, Florida

Awards and Honors
Membership in The Vedder Honors Society

Past/Present Clients
HIPAA rules do not allow me to post this information.

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