About Mark Bornfeld DDS Expertise I can respond to all questions dealing with the practice of dentistry, from both the dentist`s and patient`s perspective. I am knowledgeable about all dental disciplines, from cosmetic dentistry to surgery, from restorative dentistry to root canal treatment. I have strong opinions about controversial issues in dental practice, including those topics which directly impact on the reputation of the profession in the eyes of both the lay public and our health profession colleagues.
Experience
Past/Present Clients Editor, Queens County Academy of General Dentistry newsletter; contributor to Dentistry.com 29 years practicing general dentistry partnered with brother Steve as one-half of the DentalTwins®
Question First, thank you for volunteering your time!
I had a filling put in a back molar about 2 weeks ago. It is non-amalgam and replaces an amalgam that had a chip in it.
I had no pain before the replacement, but now when I chew on one very specific spot, it hurts. It's enough to make me chew on the other side, but left alone, there is no pain. It's not super-intense pain, but it gets my attention.
Is this common with new fillings like this? Do I bother my dentist with this problem? I am worried she will drill more and I will end up needing a root canal, so I am hoping that "these thing just happen" and also that they will nicely go away. My bite seems fine (no high spots that I can tell, and my dentist specifically checked), and there is no pain when I just grind my teeth together--only when I bite on something that puts pressure in the one spot. No sensitivity to hot or cold. Any thoughts or advice?
Answer Dear Kris,
Resin fillings do look nicer than amalgams, but they have several physical properties that put them at a disadvantage. Whether these disadvantages will translate into a real problem depends much on the clinical application: the extent and depth of the filling, its proximity to the pulp (nerve), the technique used in placing it, and a host of other factors. The physical properties at issue include:
1. Resin is not as hard as amalgam. This means that when subjected to a comparable amount of functional stress, resin will abrade and wear more quickly.
2. Resin has poorer compressive and tensile strength than amalgam. The consequence is that resin restorations tend to break more easily than amalgam.
3. Resin contracts as it sets. This means that there is a tendency for resin to pull away from the cavity margins as it is polymerized, tending to promote leakage around the filling. This marginal gapping can be reduced by acid etching and bonding, but this allows the shrinkage that occurs during setting to exert significant forces on the walls of the cavity. This can theoretically lead to fracture of the tooth.
4. Resin has a coefficient of thermal expansion that differs more markedly from that of the tooth than does amalgam. This means that when the tooth is subjected to changes of temperature (as will happen when alternately consuming hot and cold foods), the gap between a filling and the cavity it fills will open and close more dramatically in the case of resin than in the case of amalgam.
5. The placement of resin is more complicated than the placement of amalgam, and requires the use of acidic etchants and monomeric compounds that have the potential for greater pulpal irritation.
Now, that is a rather severe diatribe against the use of resin, but must be viewed in the context of real-world situations. Few persons would find the appearance of an amalgam to be acceptable in a front tooth, and composite resin is a most appropriate material in such a setting. However, the trade-off between cosmetics and function makes less sense in a molar, where appearance is not nearly as urgent an issue. Not that the use of resin is fundamentally wrong in visually inconspicuous areas, but a patient should be aware of the relative merits of the available filling materials, and should be included in the decision-making.
As far as the appropriate course for your tooth-- as I have alluded to above, there is a relatively high probability of postoperative sensitivity following the placement of a resin filling. This sensitivity is sometimes the result of a relatively trivial, short-term pulpal irritation that will resolve on its own. However, such early sensitivity is often indistinguishable from more serious complications, such as a cuspal fracture from polymerization shrinkage or an irreversible pulpitis. At only two weeks post-op, it is too soon to draw any conclusions from the quality or severity of the symptoms alone. I would recommend that you be mindful of the symptoms over the next two or three weeks, and take special note of any improving or worsening trend. A diminution of the symptoms is, of course, a good sign, and would indicate that (in all likelihood) no further attention will be needed. Conversely, a sudden increase in severity or even a moderate but noticeable upward trend in the symptoms would call for a return visit to your dentist for a more in-depth re-assessment of the tooth.
Good luck!
Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY
