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®
I had a composite filling done on an upper right molar about a month ago. The tooth was very sensitive to hot/cold & did not respond to ozone or other sealants. My dentist took an x-ray & sis a pulp test and found the tooth to be sound so she did a filling on the "face" of the tooth.
The next day the tooth started hurting. It started with a jabbing feeling between the tooth as if something was stuck in my gum & eventually it spread into a diffuse, nagging pain. Not throbing like an abcess though.
I then had the tooth examined & re-filled in composite by another dentist who assured me that she had never had a patient have any kind of allergic reaction to composite but that different materials & techniques could make a difference. She diagnosed it as reversible pulpitis.
The tooth felt fine for about a week & then I started getting intermitent pain. I hoped this might be due to a cold I had a few weeks ago & that it would go away. Yesterday it started hurting non-stop again. Eventhough my cold is gone I tried taking a decongestant to see if that helped. It has not. It hurts constantly, not in response to hot/cold.
I'm at my witts end and hoping you may have a fresh opinion.
Many thanks,
Josée
Answer Dear Josée,
Even under the best of circumstances, the placement of a composite resin filling can provoke sensitivity. The tooth must first be prepared with a phosphoric acid etchant, the resin must then be polymerized with a hot quartz-halogen lamp, the resin tends to contract during polymerization, creating tensile stresses and potential leakage, and the chemical nature of the resin itself can evoke inflammatory changes in the pulp (nerve) of the tooth. Collectively, these properties of resin will irritate the tooth, and can make a calm tooth sensitive, and a sensitive tooth more sensitive. This has nothing to do with allergy, in much the same way that an acid burn to the skin has nothing to do with allergy.
For this reason, the placement of a resin filling in a tooth that is already sensitive is exactly the thing that should not be done, and the outcome of this treatment should not have been a surprise. In fact, the benefit of hindsight probably would lead your dentist to the deduction that despite the previously taken x-ray and pulp test, the pulpal health of the tooth is not "sound" as previously proclaimed. I have witnessed many cases where there was insufficient objective evidence that pulpitis or abscess was present, but the subjective symptoms told otherwise. Without being able to examine you personally, I cannot be certain, but your narrative clearly implies that you need more than a simple filling-- perhaps a root canal treatment. At the very least, you should consider having the resin filling temporarily replaced with a sedative dressing to see if the symptoms resolve before pondering your next move. Even so, the sequence of events strongly suggests that you will need a root canal treatment, if this is feasible, unless there is a concurrent problem in the area that has yet to be diagnosed.
Good luck!
Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY
